Healthcare Provider Details

I. General information

NPI: 1457424939
Provider Name (Legal Business Name): ANN FOSTER GOLAY EDD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 N HARBOR BLVD STE 800
FULLERTON CA
92835-4120
US

IV. Provider business mailing address

1440 N HARBOR BLVD STE 800
FULLERTON CA
92835-4121
US

V. Phone/Fax

Practice location:
  • Phone: 714-681-2355
  • Fax: 714-844-9132
Mailing address:
  • Phone: 714-681-2355
  • Fax: 714-844-9132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 15522
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLEP 2784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: