Healthcare Provider Details

I. General information

NPI: 1811537798
Provider Name (Legal Business Name): GEOFFRY KETTLING LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 MILL ST
RENO NV
89502-1321
US

IV. Provider business mailing address

770 MILL ST
RENO NV
89502-1321
US

V. Phone/Fax

Practice location:
  • Phone: 775-636-7767
  • Fax:
Mailing address:
  • Phone: 775-636-7767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMI1220
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT4897
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: