1770724924 NPI number — AMY CAROL GOLD MA; LMFT

Table of content: AMY CAROL GOLD MA; LMFT (NPI 1770724924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770724924 NPI number — AMY CAROL GOLD MA; LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLD
Provider First Name:
AMY
Provider Middle Name:
CAROL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA; LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770724924
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1409 WILLOW ST
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55403-2269
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-872-2343
Provider Business Mailing Address Fax Number:
360-233-0649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1409 WILLOW ST
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55403-2269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-872-2343
Provider Business Practice Location Address Fax Number:
360-233-0649
Provider Enumeration Date:
03/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  LMFT1146 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: M488355100 . This is a "MEDICAL ASSISSTANCE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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