Provider Demographics
NPI:1790214666
Name:WRENN, GEOFFREY RICHARD (MA)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:RICHARD
Last Name:WRENN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18430 BROOKHURST ST STE 201F
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6757
Mailing Address - Country:US
Mailing Address - Phone:714-851-9245
Mailing Address - Fax:714-526-1247
Practice Address - Street 1:18430 BROOKHURST ST STE 201F
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6757
Practice Address - Country:US
Practice Address - Phone:714-851-9245
Practice Address - Fax:714-526-1247
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112671106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist