Provider Demographics
NPI:1366651879
Name:GODDARD, GERI A (MA, MFT)
Entity Type:Individual
Prefix:
First Name:GERI
Middle Name:A
Last Name:GODDARD
Suffix:
Gender:F
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 1:4790 CAUGHLIN PKWY # 383
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-0907
Mailing Address - Country:US
Mailing Address - Phone:775-826-1002
Mailing Address - Fax:
Practice Address - Street 1:615 SIERRA ROSE DR STE 4
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-4009
Practice Address - Country:US
Practice Address - Phone:775-826-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0587106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist