Provider Demographics
NPI:1467542753
Name:GOOLD, DOROTHEA MUELLER (MS,LMFT)
Entity Type:Individual
Prefix:
First Name:DOROTHEA
Middle Name:MUELLER
Last Name:GOOLD
Suffix:
Gender:F
Credentials:MS,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8426 VIBURNUM CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2277
Mailing Address - Country:US
Mailing Address - Phone:317-833-5268
Mailing Address - Fax:
Practice Address - Street 1:1005 S MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-2784
Practice Address - Country:US
Practice Address - Phone:765-482-7421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35000767A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist