Provider Demographics
NPI:1053684621
Name:GEORGE, ROBERT IRVIN (MA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:IRVIN
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 BRIGHTON HILLS PL NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-0825
Mailing Address - Country:US
Mailing Address - Phone:505-771-0135
Mailing Address - Fax:
Practice Address - Street 1:5020 BRIGHTON HILLS PL NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-0825
Practice Address - Country:US
Practice Address - Phone:505-771-0135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor