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Individual

GEOFFREY D NUSBAUM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
333 N 18TH AVE STE A, POCATELLO, ID 83201-3358
(208) 234-2660
Mailing address
PO BOX 4449, POCATELLO, ID 83205-4449
(208) 234-2660
(208) 234-2661

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LMFT-38
ID
101Y00000X
Counselor
MF000283
PA
101Y00000X
Counselor
NJ

Other

Enumeration date
07/23/2006
Last updated
07/08/2007
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