Provider Demographics
NPI:1578904561
Name:REDDICK, GEOFFREY T (LMFT)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:T
Last Name:REDDICK
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7307 DEVONSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-8464
Mailing Address - Country:US
Mailing Address - Phone:479-466-2936
Mailing Address - Fax:
Practice Address - Street 1:2105 S 54TH ST STE 2
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8191
Practice Address - Country:US
Practice Address - Phone:479-373-2377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001418106H00000X
ARM1901001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist