Provider Demographics
NPI:1306086475
Name:GOLDEN, BRYAN (ACA, BC-HIS)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:ACA, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 W CAMPBELL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3300
Mailing Address - Country:US
Mailing Address - Phone:972-783-1823
Mailing Address - Fax:972-664-9580
Practice Address - Street 1:648 W CAMPBELL RD
Practice Address - Street 2:SUITE A
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3300
Practice Address - Country:US
Practice Address - Phone:972-783-1823
Practice Address - Fax:972-664-9580
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50093237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180800801Medicaid