Provider Demographics
NPI:1477687465
Name:GEORGESON, CAROL BETH (LMFT)
Entity type:Individual
Prefix:MISS
First Name:CAROL
Middle Name:BETH
Last Name:GEORGESON
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 1:200 HAWTHORNE AVE SE STE D480
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-5292
Mailing Address - Country:US
Mailing Address - Phone:503-897-8015
Mailing Address - Fax:
Practice Address - Street 1:200 HAWTHORNE AVE SE STE D480
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5292
Practice Address - Country:US
Practice Address - Phone:503-897-8015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91197106H00000X
ORT1438106H00000X
CAIMF 43483251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered251S00000XAgenciesCommunity/Behavioral Health