Provider Demographics
NPI:1235572710
Name:LANDERS-NOLAN, GEOFFREY (MED)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:
Last Name:LANDERS-NOLAN
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:GEOFF
Other - Middle Name:
Other - Last Name:LANDERS-NOLAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, LPC, CAADC
Mailing Address - Street 1:311 CHADHAM CT
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-7613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:253 EASTERLY PKWY # 205
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-6301
Practice Address - Country:US
Practice Address - Phone:814-531-5659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
PAPC010716101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)