Basic Information
| Provider Information | |||||||||
| NPI: | 1144821356 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GOLDEN OAK FAMILY COUNSELING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 42445 GOLDEN OAK LN | ||||||||
| Address2: | |||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925903155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9515141659 | ||||||||
| FaxNumber: | 9513448354 | ||||||||
| Practice Location | |||||||||
| Address1: | 28481 RANCHO CALIFORNIA RD STE 210 | ||||||||
| Address2: | |||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925903619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517681580 | ||||||||
| FaxNumber: | 9513448354 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2020 | ||||||||
| LastUpdateDate: | 11/04/2020 | ||||||||
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| AuthorizedOfficialLastName: | THURMAN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9515141659 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMFT, LAADC | ||||||||
| NPICertificationDate: | 11/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 106H00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.