Provider Demographics
NPI:1215081914
Name:GOULDEN, LAURA (PHD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GOULDEN
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 1:2450A OLD SHELL RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3020
Mailing Address - Country:US
Mailing Address - Phone:251-476-9011
Mailing Address - Fax:251-300-8578
Practice Address - Street 1:2450A OLD SHELL RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3020
Practice Address - Country:US
Practice Address - Phone:251-476-9011
Practice Address - Fax:251-300-8578
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL984103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS80889Medicare UPIN