Provider Demographics
NPI:1629532981
Name:GOLDEN, DESIREE (RMTI - LMMT - CLC)
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:RMTI - LMMT - CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 CANTERRA ARC
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-1805
Mailing Address - Country:US
Mailing Address - Phone:575-932-9741
Mailing Address - Fax:
Practice Address - Street 1:4310 CANTERRA ARC
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-1805
Practice Address - Country:US
Practice Address - Phone:575-932-9741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRMTIS0526172P00000X, 173C00000X, 174H00000X
NMMT7474175F00000X, 225700000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No172P00000XOther Service ProvidersNaprapath
No173C00000XOther Service ProvidersReflexologist
No174H00000XOther Service ProvidersHealth Educator
No175F00000XOther Service ProvidersNaturopath
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist