Provider Demographics
NPI:1033865274
Name:MOSHER, GEOFFREY ELTON JAMES (AMFT, APCC)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:ELTON JAMES
Last Name:MOSHER
Suffix:
Gender:M
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34428 YUCAIPA BLVD
Mailing Address - Street 2:STE E #277
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2474
Mailing Address - Country:US
Mailing Address - Phone:909-871-9033
Mailing Address - Fax:
Practice Address - Street 1:940 E WILLIAMS ST STE 102
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-5848
Practice Address - Country:US
Practice Address - Phone:951-588-2553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC10693101YP2500X
CAAMFT128958106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional