Provider Demographics
NPI:1093877094
Name:GEORGE, PAUL N (MS LCSW LMFT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:N
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MS LCSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6284 RUCKER RD
Mailing Address - Street 2:STE N
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4851
Mailing Address - Country:US
Mailing Address - Phone:317-475-1389
Mailing Address - Fax:
Practice Address - Street 1:6284 RUCKER RD
Practice Address - Street 2:STE N
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4851
Practice Address - Country:US
Practice Address - Phone:317-475-1389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002279A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000112975OtherBCBS ID
IN000000112975OtherBCBS ID