Provider Demographics
NPI:1821316332
Name:GOLDE, JEFFREY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:GOLDE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 N LA PALMA RD
Mailing Address - Street 2:LA PALMA CORRECTIONAL CENTER / MENTAL HEALTH SERVICES
Mailing Address - City:ELOY
Mailing Address - State:AZ
Mailing Address - Zip Code:85131-9641
Mailing Address - Country:US
Mailing Address - Phone:520-464-3389
Mailing Address - Fax:
Practice Address - Street 1:5501 N LA PALMA RD
Practice Address - Street 2:LA PALMA CORRECTIONAL CENTER / MENTAL HEALTH SERVICES
Practice Address - City:ELOY
Practice Address - State:AZ
Practice Address - Zip Code:85131-9641
Practice Address - Country:US
Practice Address - Phone:520-464-3389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3421103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist