Provider Demographics
NPI:1649507922
Name:GOLDEN, KIM A (MA)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:A
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 S SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-9773
Mailing Address - Country:US
Mailing Address - Phone:509-255-0500
Mailing Address - Fax:
Practice Address - Street 1:523 S SHORELINE DR
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-9773
Practice Address - Country:US
Practice Address - Phone:509-255-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-07
Last Update Date:2009-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007181101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health