Healthcare Provider Details

I. General information

NPI: 1760752364
Provider Name (Legal Business Name): GEORGE FRED DEATON LPC-MHSP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 UNIVERSITY ST
MARTIN TN
38237-1605
US

IV. Provider business mailing address

PO BOX 640
MCMINNVILLE TN
37111-0640
US

V. Phone/Fax

Practice location:
  • Phone: 731-588-5829
  • Fax: 731-588-5834
Mailing address:
  • Phone: 931-507-1212
  • Fax: 931-507-1217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC0000000498
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: