Provider Demographics
NPI:1679279723
Name:GOLDEN HEART FAMILY THERAPY, LLC
Entity Type:Organization
Organization Name:GOLDEN HEART FAMILY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MARRIAGE & FAMILY THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVAN
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:907-750-3010
Mailing Address - Street 1:PO BOX 60474
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99706-9998
Mailing Address - Country:US
Mailing Address - Phone:907-750-3010
Mailing Address - Fax:907-600-5066
Practice Address - Street 1:626 2ND ST.
Practice Address - Street 2:STE 303
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701
Practice Address - Country:US
Practice Address - Phone:907-750-3010
Practice Address - Fax:907-600-5066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1558691105OtherINDIVIDUAL NPI