MEDICARE: ALYSON GOULD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner
2	106H00000X	Marriage & Family Therapist	105158	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669881082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSON GOULD

Provider Business Mailing Address
First Line	:	239 E MONTANA ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-1059
Country	:	US
Telephone Number	:	818-421-8277
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 N CENTRAL AVE STE 310
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-2937
Country	:	US
Telephone Number	:	818-724-9770
Fax Number	:	818-484-2991

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2014
Last Update Date	:	11/21/2018

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Directions to “ ALYSON GOULD ” Practice Location

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