Healthcare Provider Details

I. General information

NPI: 1407191562
Provider Name (Legal Business Name): DAVID NEAL GOLDSTEIN LCPC 6008
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2012
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 PARKCENTRE WAY STE 4
NAMPA ID
83651-1794
US

IV. Provider business mailing address

1843 E MEADOWGRASS ST
MERIDIAN ID
83646-7314
US

V. Phone/Fax

Practice location:
  • Phone: 208-467-2673
  • Fax:
Mailing address:
  • Phone: 407-666-8911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCADC 10268
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH9472
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC 6008
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCPC 6008
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: