Provider Demographics
NPI:1255336111
Name:GOLDEN, JO ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:JO ANNE
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 SLATER AVE
Mailing Address - Street 2:STE 237
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4723
Mailing Address - Country:US
Mailing Address - Phone:714-968-4202
Mailing Address - Fax:714-968-4302
Practice Address - Street 1:10101 SLATER AVE
Practice Address - Street 2:STE 237
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4723
Practice Address - Country:US
Practice Address - Phone:714-968-4202
Practice Address - Fax:714-968-4302
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15537103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical