Provider Demographics
NPI:1265657449
Name:GOLD, JEFF MICHAEL
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:MICHAEL
Last Name:GOLD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 DRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-9324
Mailing Address - Country:US
Mailing Address - Phone:932-526-8589
Mailing Address - Fax:
Practice Address - Street 1:1751 DRY CREEK RD
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-9324
Practice Address - Country:US
Practice Address - Phone:932-526-8589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000743101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health