Healthcare Provider Details

I. General information

NPI: 1699954883
Provider Name (Legal Business Name): GEORGE ROBERT TASEFF M.A., LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17437 CAREY RD
WESTFIELD IN
46074-9439
US

IV. Provider business mailing address

17437 CAREY RD
WESTFIELD IN
46074-9439
US

V. Phone/Fax

Practice location:
  • Phone: 847-875-5422
  • Fax:
Mailing address:
  • Phone: 847-875-5422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number39005548A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.008755
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: