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General NPI Number Information
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NPI Number | 1811360258
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Entity Type | Organization
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Legal Business Name | GOLDENTHERAPYCENTER
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Dates
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Enumeration Date | 11/06/2015
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Last Update Date | 11/06/2015
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Provider Practice Location Address
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Address Line | 15300 VENTURA BLVD SUITE 509
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-3103
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Country | US
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Telephone | 818-638-1255
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Fax |
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Provider Business Mailing Address
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Address Line | 15300 VENTURA BLVD SUITE 509
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-3103
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Country | US
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Telephone | 818-638-1255
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATY GOLBAR ELLSWEIG
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Credential | M.F.T.
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Telephone | 818-638-1255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 41247
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License Number State | CA
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