Provider Demographics
NPI:1033519350
Name:GOLDEN, LAUREN A (PSYD, PLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:A
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:PSYD, PLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 PARK CENTRAL E APT 605
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65806-2225
Mailing Address - Country:US
Mailing Address - Phone:602-881-2313
Mailing Address - Fax:
Practice Address - Street 1:230 N BELCREST AVE STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-6287
Practice Address - Country:US
Practice Address - Phone:417-413-4676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018030706103TC1900X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490049877Medicaid