Provider Demographics
NPI:1184948036
Name:GOULDING, GLORIA JEAN (LMT)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:JEAN
Last Name:GOULDING
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 E CHARLESTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-1172
Mailing Address - Country:US
Mailing Address - Phone:217-474-6006
Mailing Address - Fax:
Practice Address - Street 1:3031 E CHARLESTON AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-1172
Practice Address - Country:US
Practice Address - Phone:217-474-6006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-12526174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator