Healthcare Provider Details

I. General information

NPI: 1881795060
Provider Name (Legal Business Name): LORI S GOLDEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 N CENTRAL EXPY 324
DALLAS TX
75231-8600
US

IV. Provider business mailing address

6133 YORKSHIRE DR
DALLAS TX
75230-2915
US

V. Phone/Fax

Practice location:
  • Phone: 214-228-0796
  • Fax: 214-252-9485
Mailing address:
  • Phone: 214-228-0796
  • Fax: 214-820-8219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number32276
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: