Provider Demographics
NPI:1366133092
Name:GEDDES, JOHN CHARLES (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHARLES
Last Name:GEDDES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:CHUCK
Other - Middle Name:
Other - Last Name:GEDDES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1180 DEERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-5359
Mailing Address - Country:US
Mailing Address - Phone:604-791-0983
Mailing Address - Fax:
Practice Address - Street 1:3611 CROSSINGS DR STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7181
Practice Address - Country:US
Practice Address - Phone:604-791-0983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005529103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent