Healthcare Provider Details

I. General information

NPI: 1952769192
Provider Name (Legal Business Name): GOLDA IVASHKOV HOGAN MS, LADC, MFT-INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S WATER ST STE 230
HENDERSON NV
89015-7308
US

IV. Provider business mailing address

40 N FOGG ST
LAS VEGAS NV
89110-5143
US

V. Phone/Fax

Practice location:
  • Phone: 702-451-2141
  • Fax:
Mailing address:
  • Phone: 702-408-0148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMI4565
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number07730-I
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: