=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558485953
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LORI GOLDEN, PH.D. LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 11/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10300 N CENTRAL EXPY 324
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-8600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-228-0796
-----------------------------------------------------
Fax | 214-252-9485
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6133 YORKSHIRE DR
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75230-2915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-228-0796
-----------------------------------------------------
Fax | 214-252-9485
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. LORI GOLDEN
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 214-228-0796
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 32276
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------