| Doctor Name: | JENNIFER GOLD |
| NPI Number: | 1548669146 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LAC |
| License Number: | 00850061 |
| Business Practice Address: | 520 Washington St Concordia, KS - 669012121 |
| Business Phone Number: | 7852434164 |
| Business Fax Number: | 7852434164 |
| Mailing Address: | Po Box 254, 520 Washington Street CONCORDIA |
| State: | KS |
| Postal Code: | 669010254 |
| Phone Number: | 7852434164 |
| Fax Number: | 7852434164 |
| NPI Enumeration Date: | 08/19/2014 |
| NPI Last Update Date: | 08/19/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 00850061 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |