Healthcare Provider Details

I. General information

NPI: 1972840379
Provider Name (Legal Business Name): JBG CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6855 SQUAW CREEK ROAD
JACKSON WY
83001
US

IV. Provider business mailing address

PO BOX 664
TETON VILLAGE WY
83025-0664
US

V. Phone/Fax

Practice location:
  • Phone: 307-733-1453
  • Fax:
Mailing address:
  • Phone: 307-733-1453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JULIA BETH GOLDENSOHN
Title or Position: LICENSED PSYCHOLOGIST
Credential: PSY.D.
Phone: 307-733-8210