Provider Demographics
NPI:1609093095
Name:GOLDEN, SANDRA J (MPH,BHRS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:MPH,BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 1011
Mailing Address - Street 2:
Mailing Address - City:CLEARVIEW
Mailing Address - State:OK
Mailing Address - Zip Code:74880-9504
Mailing Address - Country:US
Mailing Address - Phone:405-786-2635
Mailing Address - Fax:405-786-2635
Practice Address - Street 1:325 S WASHITA ST
Practice Address - Street 2:
Practice Address - City:WETUMKA
Practice Address - State:OK
Practice Address - Zip Code:74883-5522
Practice Address - Country:US
Practice Address - Phone:405-452-1300
Practice Address - Fax:405-452-3802
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100744410AMedicaid