Provider Demographics
NPI:1477687465
Name:GEORGESON, CAROL BETH (LMFT)
Entity Type:Individual
Prefix:MISS
First Name:CAROL
Middle Name:BETH
Last Name:GEORGESON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 STABLER LANE
Mailing Address - Street 2:SUITE 630 BOX #293
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993
Mailing Address - Country:US
Mailing Address - Phone:530-415-0953
Mailing Address - Fax:
Practice Address - Street 1:1965 LIVE OAK BLVD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-8828
Practice Address - Country:US
Practice Address - Phone:530-822-7200
Practice Address - Fax:530-822-7108
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91197101YM0800X, 106H00000X
CAIMF 43483251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered251S00000XAgenciesCommunity/Behavioral Health