Healthcare Provider Details

I. General information

NPI: 1093686131
Provider Name (Legal Business Name): SETH GEDDES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 SAMOA BLVD STE 209
ARCATA CA
95521-6696
US

IV. Provider business mailing address

PO BOX 1254
WILLOW CREEK CA
95573-1254
US

V. Phone/Fax

Practice location:
  • Phone: 707-940-9528
  • Fax:
Mailing address:
  • Phone: 707-940-9528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: