Provider Demographics
NPI:1497146443
Name:GOLDEN, SUSAN NICOLE (PHD, LMFT, SUDP)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:NICOLE
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:PHD, LMFT, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 164TH ST SE STE B12-312
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6385
Mailing Address - Country:US
Mailing Address - Phone:425-870-9968
Mailing Address - Fax:
Practice Address - Street 1:914 164TH ST SE STE B12-312
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-6385
Practice Address - Country:US
Practice Address - Phone:425-870-9968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60279910101YM0800X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health