MEDICARE: ERIN GOLDEN PSYD

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	103T00000X	Psychologist	2013020714	MO

General Provider Information

NPI Number	:	1992981195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN GOLDEN PSYD

Provider Business Mailing Address
First Line	:	2030 S NATIONAL AVE STE 105
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-2238
Country	:	US
Telephone Number	:	417-820-9590
Fax Number	:

Provider Business Practice Location Address
First Line	:	2030 S NATIONAL AVE STE 105
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-2238
Country	:	US
Telephone Number	:	417-820-9590
Fax Number	:

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

Provider Enumeration Date	:	01/17/2008
Last Update Date	:	01/02/2018

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