Provider Demographics
NPI:1881795060
Name:GOLDEN, LORI S (PHD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:S
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6133 YORKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2915
Mailing Address - Country:US
Mailing Address - Phone:214-228-0796
Mailing Address - Fax:214-820-8219
Practice Address - Street 1:10300 N CENTRAL EXPY
Practice Address - Street 2:324
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-8600
Practice Address - Country:US
Practice Address - Phone:214-228-0796
Practice Address - Fax:214-252-9485
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32276103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F4467Medicare PIN