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General NPI Number Information
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NPI Number | 1689192510
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Entity Type | Individual
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Provider Name | GEORGE SMILEDGE LPC
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Gender | Male
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Dates
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Enumeration Date | 08/30/2017
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 1838 N VALLEY MILLS DR STE 6
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City | WACO
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State | TX
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Zip | 76710-2557
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Country | US
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Telephone | 254-498-0730
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Fax | 208-216-7622
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Provider Business Mailing Address
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Address Line | 4504 ANLO AVE
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City | WACO
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State | TX
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Zip | 76710-4952
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Country | US
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Telephone | 254-498-0730
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Fax | 208-216-7762
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCPC-10510
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 95566
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License Number State | TX
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