Provider Demographics
NPI:1285379586
Name:GOLDBAUM, TEMIMA BASYA (LPCC, ATR)
Entity type:Individual
Prefix:
First Name:TEMIMA
Middle Name:BASYA
Last Name:GOLDBAUM
Suffix:
Gender:F
Credentials:LPCC, ATR
Other - Prefix:
Other - First Name:TEMIMA
Other - Middle Name:
Other - Last Name:KOVEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3586 BENDEMEER RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1954
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3109 MAYFIELD RD STE 204
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1726
Practice Address - Country:US
Practice Address - Phone:216-245-2696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE22028731041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical