Provider Demographics
NPI:1932253291
Name:GOLDENSOHN, JULIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:
Last Name:GOLDENSOHN
Suffix:
Gender:F
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:PO BOX 664
Mailing Address - Street 2:
Mailing Address - City:TETON VILLAGE
Mailing Address - State:WY
Mailing Address - Zip Code:83025-0664
Mailing Address - Country:US
Mailing Address - Phone:307-734-4277
Mailing Address - Fax:307-739-1233
Practice Address - Street 1:610 W. BROADWAY
Practice Address - Street 2:LO2G
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001
Practice Address - Country:US
Practice Address - Phone:307-734-4277
Practice Address - Fax:307-739-1233
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY208103T00000X, 103TC0700X, 103TC2200X, 103TM1800X, 103TP2701X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY165749Medicaid