Provider Demographics
NPI:1639537012
Name:GOLDER ENTERPRISES LLC,
Entity Type:Organization
Organization Name:GOLDER ENTERPRISES LLC,
Other - Org Name:MOMENTUM MENTAL AND BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:OLDER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:208-201-8881
Mailing Address - Street 1:3867 E 12 N STE 4
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-4715
Mailing Address - Country:US
Mailing Address - Phone:208-754-0911
Mailing Address - Fax:298-228-0332
Practice Address - Street 1:3867 E 12 N STE 4
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-4715
Practice Address - Country:US
Practice Address - Phone:208-754-0911
Practice Address - Fax:208-228-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-32292101YM0800X, 251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty