=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215116694
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. GEORGE PAUL COMMISSIONG
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2007
-----------------------------------------------------
Last Update Date | 11/01/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1405 W MICHIGAN ST
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32805-6123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-650-6223
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4445 OLD WINTER GARDEN RD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32811-4244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-625-0561
-----------------------------------------------------
Fax | 407-297-2004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH7099
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------