Provider Demographics
NPI:1023137676
Name:GOULD, MICHAEL AARON (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:AARON
Last Name:GOULD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4570 VAN NUYS BLVD
Mailing Address - Street 2:#434
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2913
Mailing Address - Country:US
Mailing Address - Phone:818-419-1485
Mailing Address - Fax:
Practice Address - Street 1:4570 VAN NUYS BLVD
Practice Address - Street 2:#434
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2913
Practice Address - Country:US
Practice Address - Phone:818-419-1485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16620103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist