Provider Demographics
NPI:1235553215
Name:GOLDEN PSYCHIATRY, LLC
Entity Type:Organization
Organization Name:GOLDEN PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTLIEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-716-8013
Mailing Address - Street 1:1707 COLE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3220
Mailing Address - Country:US
Mailing Address - Phone:303-763-4900
Mailing Address - Fax:
Practice Address - Street 1:1707 COLE BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-3220
Practice Address - Country:US
Practice Address - Phone:303-763-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46585261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health