| Genesis Counseling Service | |
|
1201 N China Lake Blvd Ridgecrest CA 93555-2660 | |
| (760) 375-6348 | |
| Not Available |
| Full Name | Genesis Counseling Service |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 1201 N China Lake Blvd, Ridgecrest, California |
| Authorized Official Name and Position | Susan Knepp Logan (SATELITE DIRECTOR) |
| Authorized Official Contact | 7603756348 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis Counseling Service 202 E Airport Dr Suite #175 San Bernardino CA 92408-3444 Ph: (909) 890-2299 | Genesis Counseling Service 1201 N China Lake Blvd Ridgecrest CA 93555-2660 Ph: (760) 375-6348 |
| NPI Number | 1417134123 |
|---|---|
| Provider Enumeration Date | 01/24/2008 |
| Last Update Date | 01/24/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417134123 | NPI | - | NPPES |
| ZZZ66427Z | Other | CA | BLUE SHIELD CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | MFT24526 (California) | Primary |
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