Provider Demographics
NPI:1861873432
Name:MOEHL, GEOFFREY II (MFTI)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:
Last Name:MOEHL
Suffix:II
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4038 CAROLWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-7901
Mailing Address - Country:US
Mailing Address - Phone:407-859-2968
Mailing Address - Fax:
Practice Address - Street 1:4038 CAROLWOOD ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-7901
Practice Address - Country:US
Practice Address - Phone:407-859-2968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT 1929106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist