Provider Demographics
NPI:1124110416
Name:SCHILLER, GEOFFREY C (MSW, LICSW, CMHS)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:C
Last Name:SCHILLER
Suffix:
Gender:M
Credentials:MSW, LICSW, CMHS
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 863
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:WA
Mailing Address - Zip Code:98631
Mailing Address - Country:US
Mailing Address - Phone:360-642-6787
Mailing Address - Fax:360-642-2096
Practice Address - Street 1:1107 PACIFIC HIGHWAY NORTH
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:WA
Practice Address - Zip Code:98631
Practice Address - Country:US
Practice Address - Phone:360-642-3787
Practice Address - Fax:360-642-2096
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000047511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA911324228-98586-A003OtherTRIWEST
WASC9386OtherREGENCE
WAG800804Medicare ID - Type UnspecifiedMEDICARE