Provider Demographics
NPI:1306866116
Name:GEIGER, JEROME MARTIN (EDD)
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:MARTIN
Last Name:GEIGER
Suffix:
Gender:M
Credentials:EDD
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 3906
Mailing Address - Street 2:DBA COUNSELING WESTERN PROFESSIONAL CONSULTING SERVICE
Mailing Address - City:BAY PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33744-3906
Mailing Address - Country:US
Mailing Address - Phone:727-398-5411
Mailing Address - Fax:
Practice Address - Street 1:5444 PARK BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33787-3300
Practice Address - Country:US
Practice Address - Phone:727-398-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4050103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist