Provider Demographics
NPI:1407191562
Name:GOLDSTEIN, DAVID NEAL (LCPC 6008)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:NEAL
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:LCPC 6008
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1843 E MEADOWGRASS ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-7314
Mailing Address - Country:US
Mailing Address - Phone:407-666-8911
Mailing Address - Fax:
Practice Address - Street 1:847 PARKCENTRE WAY STE 4
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1794
Practice Address - Country:US
Practice Address - Phone:208-467-2673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH9472101YM0800X
IDLCPC 6008101YM0800X, 101YP2500X
IDCADC 10268101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional