Healthcare Provider Details

I. General information

NPI: 1306754403
Provider Name (Legal Business Name): MADELINE GEERKEN AMFT #162890
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 FASHION LN STE 210
TUSTIN CA
92780-3319
US

IV. Provider business mailing address

517 PECAN AVE
HUNTINGTON BEACH CA
92648-4622
US

V. Phone/Fax

Practice location:
  • Phone: 213-222-6553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: