Provider Demographics
NPI:1043682586
Name:GERIATRIC COUNSELING SERVICES
Entity Type:Organization
Organization Name:GERIATRIC COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-466-0370
Mailing Address - Street 1:3936 SYME DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-3569
Mailing Address - Country:US
Mailing Address - Phone:866-309-3332
Mailing Address - Fax:855-872-6151
Practice Address - Street 1:3936 SYME DR
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-3569
Practice Address - Country:US
Practice Address - Phone:866-309-3332
Practice Address - Fax:855-872-6151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11450103T00000X
CAPSY14791103T00000X
CAPSY4650103TC0700X
CAPSY12736103TC0700X
CAPSY4623103TC0700X
CAPSY13951103TC0700X
CALCS163791041C0700X
CALCS232291041C0700X
CALCS219251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty