Provider Demographics
NPI:1730510744
Name:GEIS, ROBYN LISA BETTENHAUSEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBYN
Middle Name:LISA BETTENHAUSEN
Last Name:GEIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ROBYN
Other - Middle Name:LISA
Other - Last Name:BETTENHAUSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:840 TOWN AND COUNTRY ROAD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-558-9266
Mailing Address - Fax:
Practice Address - Street 1:840 TOWN & COUNTRY RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-558-9266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15590103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily