Provider Demographics
NPI:1497927453
Name:LINVILLE, GEOFFREY L
Entity Type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:L
Last Name:LINVILLE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:GEOFFREY
Other - Middle Name:L
Other - Last Name:LINVILLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RC
Mailing Address - Street 1:PO BOX 2569
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98213-0569
Mailing Address - Country:US
Mailing Address - Phone:425-493-5805
Mailing Address - Fax:
Practice Address - Street 1:1021 N BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1405
Practice Address - Country:US
Practice Address - Phone:425-493-5805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC60019285101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANA00087923OtherNURSING ASSISTANT- REGIST