Provider Demographics
NPI:1629528484
Name:MCGEOCH, KEVIN A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:A
Last Name:MCGEOCH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-0102
Mailing Address - Country:US
Mailing Address - Phone:707-245-5582
Mailing Address - Fax:
Practice Address - Street 1:572 LAKEPORT BLVD
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-5420
Practice Address - Country:US
Practice Address - Phone:707-245-5582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2020-06-25
Deactivation Date:2020-06-19
Deactivation Code:
Reactivation Date:2020-06-25
Provider Licenses
StateLicense IDTaxonomies
CA950981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical