# GENESIS COUNSELING SERVICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417134123
- **Authorized official:** MRS. SUSAN KNEPP LOGAN MFT (SATELITE DIRECTOR)
- **Authorized official phone:** (760) 375-6348

## Contact information

- **Practice address:** 1201 N CHINA LAKE BLVD, RIDGECREST, CA 93555-2660
- **Practice address phone:** (760) 375-6348
- **Mailing address:** 202 E AIRPORT DR, SUITE \#175, SAN BERNARDINO, CA 92408-3444
- **Mailing address phone:** (909) 890-2299

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | MFT24526 | CA | Yes |

## Other

- **Enumeration date:** 01/24/2008
- **Last updated:** 01/24/2008