Healthcare Provider Details

I. General information

NPI: 1124502877
Provider Name (Legal Business Name): WHITNEY GEORGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date: 08/23/2021
Reactivation Date: 09/02/2021

III. Provider practice location address

PO BOX 1117
TORRINGTON WY
82240-1117
US

IV. Provider business mailing address

PO BOX 1117
TORRINGTON WY
82240-1117
US

V. Phone/Fax

Practice location:
  • Phone: 307-532-4197
  • Fax:
Mailing address:
  • Phone: 307-532-4197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-2263
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12695
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: