Healthcare Provider Details

I. General information

NPI: 1881054351
Provider Name (Legal Business Name): MAURICE GEDDIS MFTI, PCCI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 EMPIRE ST FL 2 SUITE2300
FAIRFIELD CA
94533-5711
US

IV. Provider business mailing address

7744 GEORGE RIVER LN
SACRAMENTO CA
95831-5817
US

V. Phone/Fax

Practice location:
  • Phone: 707-384-7303
  • Fax:
Mailing address:
  • Phone: 916-806-7567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPCCI2239
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFTI88734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: