Provider Demographics
NPI:1013369875
Name:CALASA, GEORGE (LPCC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:CALASA
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16321 ASKIN DR # 6688
Mailing Address - Street 2:
Mailing Address - City:PINE MOUNTAIN CLUB
Mailing Address - State:CA
Mailing Address - Zip Code:93222-9900
Mailing Address - Country:US
Mailing Address - Phone:805-850-3057
Mailing Address - Fax:
Practice Address - Street 1:16321 ASKIN DR # 6688
Practice Address - Street 2:
Practice Address - City:PINE MOUNTAIN CLUB
Practice Address - State:CA
Practice Address - Zip Code:93222-9900
Practice Address - Country:US
Practice Address - Phone:805-850-3057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 101YP2500X
CA7367101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1922634377Medicaid
NVCP3180-ROtherLICENSE