Healthcare Provider Details

I. General information

NPI: 1669881082
Provider Name (Legal Business Name): ALYSON GOULD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N CENTRAL AVE STE 310
GLENDALE CA
91202-2937
US

IV. Provider business mailing address

239 E MONTANA ST
PASADENA CA
91104-1059
US

V. Phone/Fax

Practice location:
  • Phone: 818-724-9770
  • Fax: 818-484-2991
Mailing address:
  • Phone: 818-421-8277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number105158
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: