Basic Information
| Provider Information | |||||||||
| NPI: | 1700826765 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEORGE | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 123 S BROAD ST | ||||||||
| Address2: | STE 234 | ||||||||
| City: | LANCASTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406548716 | ||||||||
| FaxNumber: | 7406539252 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 S BROAD ST | ||||||||
| Address2: | STE 234 | ||||||||
| City: | LANCASTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406548716 | ||||||||
| FaxNumber: | 7406539252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 5328 | OH | X | Behavioral Health & Social Service Providers | Psychologist | 103TA0700X | 5328 | OH | X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | 103TC0700X | 5328 | OH | X | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.