Provider Demographics
NPI:1801044383
Name:WISEN, GEORGEANNE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:GEORGEANNE
Middle Name:
Last Name:WISEN
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 1:391 S MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3375
Mailing Address - Country:US
Mailing Address - Phone:562-201-7444
Mailing Address - Fax:
Practice Address - Street 1:391 S MADISON AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3375
Practice Address - Country:US
Practice Address - Phone:562-201-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57786106H00000X
CA51784106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist