Healthcare Provider Details

I. General information

NPI: 1922634377
Provider Name (Legal Business Name): GEORGE CALASA LICENSED PROFESSIONAL CLINICAL COUNSELOR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16321 ASKIN DR # 6688
PINE MOUNTAIN CLUB CA
93222-9900
US

IV. Provider business mailing address

16321 ASKIN DR # 6688
PINE MOUNTAIN CLUB CA
93222-9900
US

V. Phone/Fax

Practice location:
  • Phone: 805-850-3057
  • Fax:
Mailing address:
  • Phone: 805-850-3057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE CALASA
Title or Position: COUNSELOR/OWNER/CLINICAL DIRECTOR
Credential: LPCC, LCPC, NCC
Phone: 805-850-3057