Provider Demographics
NPI:1205042843
Name:WINFREE, GEOFFREY R (MFT)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:R
Last Name:WINFREE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:GEOFF
Other - Middle Name:
Other - Last Name:WINFREE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:370 S 5TH E
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-2537
Mailing Address - Country:US
Mailing Address - Phone:208-201-6344
Mailing Address - Fax:208-356-3414
Practice Address - Street 1:36 N 2ND W
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1515
Practice Address - Country:US
Practice Address - Phone:208-359-0519
Practice Address - Fax:208-356-3414
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT 3332106H00000X
ORT0372106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDQ7423OtherBLUECROSS OF IDAHO