Healthcare Provider Details

I. General information

NPI: 1700826765
Provider Name (Legal Business Name): DAVID GEORGE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S BROAD ST STE 234
LANCASTER OH
43130
US

IV. Provider business mailing address

123 S BROAD ST STE 234
LANCASTER OH
43130
US

V. Phone/Fax

Practice location:
  • Phone: 740-654-8716
  • Fax: 740-653-9252
Mailing address:
  • Phone: 740-654-8716
  • Fax: 740-653-9252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5328
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number5328
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5328
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: