Healthcare Provider Details

I. General information

NPI: 1346688280
Provider Name (Legal Business Name): SHEILA DAWN GEORGE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

868 COUNTY ROAD 1067
AUXVASSE MO
65231-3113
US

IV. Provider business mailing address

868 COUNTY ROAD 1067
AUXVASSE MO
65231-3113
US

V. Phone/Fax

Practice location:
  • Phone: 573-424-1418
  • Fax:
Mailing address:
  • Phone: 573-424-1418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: