Provider Demographics
NPI:1235497819
Name:FORTNER, GERI LYNN (MFT, LCPC, LCADC)
Entity Type:Individual
Prefix:MS
First Name:GERI
Middle Name:LYNN
Last Name:FORTNER
Suffix:
Gender:F
Credentials:MFT, LCPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 303
Mailing Address - Street 2:BOX 48
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96204-9998
Mailing Address - Country:US
Mailing Address - Phone:822104-490-6226
Mailing Address - Fax:
Practice Address - Street 1:PSC 303
Practice Address - Street 2:BOX 48
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96204-9998
Practice Address - Country:US
Practice Address - Phone:8227-918-6816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44780106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist