Provider Demographics
NPI:1124198163
Name:BERNARD, GEOFFREY STERLING (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:STERLING
Last Name:BERNARD
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5564
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93456-5564
Mailing Address - Country:US
Mailing Address - Phone:805-270-2963
Mailing Address - Fax:805-270-2963
Practice Address - Street 1:500 W FOSTER RD
Practice Address - Street 2:BEHAVIORAL WELLNESS ADULT CLINIC
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-3620
Practice Address - Country:US
Practice Address - Phone:805-934-6310
Practice Address - Fax:805-270-2963
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48796106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2514Medicaid