Healthcare Provider Details

I. General information

NPI: 1790657948
Provider Name (Legal Business Name): GABRIELLE GEORGE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 N 22ND ST
SAINT JOSEPH MO
64506-2604
US

IV. Provider business mailing address

724 N 22ND ST
SAINT JOSEPH MO
64506-2604
US

V. Phone/Fax

Practice location:
  • Phone: 816-364-1501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2024026461
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: