MEDICARE: DANIEL GEORGE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	P1204051	AR

General Provider Information

NPI Number	:	1104057702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL GEORGE LPC

Provider Business Mailing Address
First Line	:	109 FRANKIE LN
Second Line	:
City	:	WHITE HALL
State	:	AR
Zip	:	71602-2685
Country	:	US
Telephone Number	:	870-247-3588
Fax Number	:	870-247-2072

Provider Business Practice Location Address
First Line	:	109 FRANKIE LN
Second Line	:
City	:	WHITE HALL
State	:	AR
Zip	:	71602-2685
Country	:	US
Telephone Number	:	870-247-3588
Fax Number	:	870-247-2072

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2009
Last Update Date	:	06/05/2019

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