Provider Demographics
NPI:1609181601
Name:GEIKEN, LISSA JOY (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISSA
Middle Name:JOY
Last Name:GEIKEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 DINGLE LN
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3963
Mailing Address - Country:US
Mailing Address - Phone:541-335-1095
Mailing Address - Fax:
Practice Address - Street 1:1 SHIELDS AVE
Practice Address - Street 2:CAPS 219 NORTH HALL
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-5270
Practice Address - Country:US
Practice Address - Phone:530-752-9923
Practice Address - Fax:530-752-9923
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24551103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling