Healthcare Provider Details

I. General information

NPI: 1790214666
Provider Name (Legal Business Name): GEOFFREY RICHARD WRENN M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18430 BROOKHURST ST STE 201F
FOUNTAIN VALLEY CA
92708-6757
US

IV. Provider business mailing address

18430 BROOKHURST ST STE 201F
FOUNTAIN VALLEY CA
92708-6757
US

V. Phone/Fax

Practice location:
  • Phone: 714-851-9245
  • Fax: 714-526-1247
Mailing address:
  • Phone: 714-851-9245
  • Fax: 714-526-1247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number112671
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: