Provider Demographics
NPI:1811360258
Name:GOLDENTHERAPYCENTER
Entity type:Organization
Organization Name:GOLDENTHERAPYCENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATY
Authorized Official - Middle Name:GOLBAR
Authorized Official - Last Name:ELLSWEIG
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:818-638-1255
Mailing Address - Street 1:15300 VENTURA BLVD
Mailing Address - Street 2:SUITE 509
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3103
Mailing Address - Country:US
Mailing Address - Phone:818-638-1255
Mailing Address - Fax:
Practice Address - Street 1:15300 VENTURA BLVD
Practice Address - Street 2:SUITE 509
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3103
Practice Address - Country:US
Practice Address - Phone:818-638-1255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41247106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty