Healthcare Provider Details

I. General information

NPI: 1922609072
Provider Name (Legal Business Name): GEORGE EDWARD KHAMIS M.A., LLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22365 LANCASTER CT
NOVI MI
48374-3974
US

IV. Provider business mailing address

549 PRESIDIO BLVD
SAN FRANCISCO CA
94129-1129
US

V. Phone/Fax

Practice location:
  • Phone: 248-916-6037
  • Fax:
Mailing address:
  • Phone: 248-916-6037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: