Provider Demographics
NPI:1881054351
Name:GEDDIS, MAURICE (MFTI, PCCI)
Entity type:Individual
Prefix:
First Name:MAURICE
Middle Name:
Last Name:GEDDIS
Suffix:
Gender:M
Credentials:MFTI, PCCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7744 GEORGE RIVER LN
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-5817
Mailing Address - Country:US
Mailing Address - Phone:916-806-7567
Mailing Address - Fax:
Practice Address - Street 1:1234 EMPIRE ST FL 2
Practice Address - Street 2:SUITE2300
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5711
Practice Address - Country:US
Practice Address - Phone:707-384-7303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPCCI2239101YP2500X
CAMFTI88734106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional