Provider Demographics
NPI:1063504900
Name:STERN, GEORGE W (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:W
Last Name:STERN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3511
Mailing Address - Country:US
Mailing Address - Phone:785-841-0724
Mailing Address - Fax:
Practice Address - Street 1:3200 MESA WAY STE D
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-2343
Practice Address - Country:US
Practice Address - Phone:785-760-3457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS750103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS119815Medicare ID - Type Unspecified