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General NPI Number Information
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NPI Number | 1104057702
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Entity Type | Individual
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Provider Name | DANIEL GEORGE LPC
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Gender | Male
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Dates
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Enumeration Date | 07/30/2009
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Last Update Date | 06/05/2019
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Provider Practice Location Address
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Address Line | 109 FRANKIE LN
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City | WHITE HALL
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State | AR
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Zip | 71602-2685
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Country | US
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Telephone | 870-247-3588
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Fax | 870-247-2072
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Provider Business Mailing Address
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Address Line | 109 FRANKIE LN
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City | WHITE HALL
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State | AR
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Zip | 71602-2685
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Country | US
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Telephone | 870-247-3588
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Fax | 870-247-2072
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P1204051
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License Number State | AR
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