Provider Demographics
NPI:1578834206
Name:GOLDEN, KATHLEEN MARIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1116
Mailing Address - Street 2:
Mailing Address - City:CONGRESS
Mailing Address - State:AZ
Mailing Address - Zip Code:85332-1116
Mailing Address - Country:US
Mailing Address - Phone:928-427-0250
Mailing Address - Fax:
Practice Address - Street 1:201 N ALARCON ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-3100
Practice Address - Country:US
Practice Address - Phone:928-231-0035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC12199101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional