Provider Demographics
NPI:1346707072
Name:GOLDEN, SCOTT (RBT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8906 N FARMDALE ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-9150
Mailing Address - Country:US
Mailing Address - Phone:509-494-9191
Mailing Address - Fax:
Practice Address - Street 1:1521 E ILLINOIS AVE STE 107
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-5147
Practice Address - Country:US
Practice Address - Phone:208-217-5529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARBT-19-79784106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician