Provider Demographics
NPI:1891122990
Name:GOLD, WILL (PSYD, LP)
Entity type:Individual
Prefix:
First Name:WILL
Middle Name:
Last Name:GOLD
Suffix:
Gender:
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11825 WOODBINE ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2671
Mailing Address - Country:US
Mailing Address - Phone:612-499-0294
Mailing Address - Fax:
Practice Address - Street 1:11825 WOODBINE ST NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2671
Practice Address - Country:US
Practice Address - Phone:612-499-0294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6422103TC0700X
MN6422103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical