MEDICARE: MR. GEORGE J LIMBERAKIS LCMHC

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	101Y00000X	Counselor	4995449-6004	UT
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	4995449-6004	UT
3	101YP2500X	Professional Counselor	4995449-6004	UT
4	101YM0800X	Mental Health Counselor	4995449-6004	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4995449-6004	OTHER	UT	STATE LIICENSE
2	113847A	OTHER	UT	DEPT ADMINISTRATIVE SERV

General Provider Information

NPI Number	:	1942277595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE J LIMBERAKIS LCMHC

Provider Business Mailing Address
First Line	:	PO BOX 526265
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84152-6265
Country	:	US
Telephone Number	:	801-487-4298
Fax Number	:	801-606-7873

Provider Business Practice Location Address
First Line	:	1399 S 700 E STE 12E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2149
Country	:	US
Telephone Number	:	801-487-4298
Fax Number	:	801-606-7873

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

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	08/22/2019

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