Provider Demographics
NPI:1114079126
Name:LOUGH, GEORGE JACOB II (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JACOB
Last Name:LOUGH
Suffix:II
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 1:12444 VENTURA BL., SUITE 206
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2409
Mailing Address - Country:US
Mailing Address - Phone:818-980-0606
Mailing Address - Fax:
Practice Address - Street 1:12444 VENTURA BLVD STE 206
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2409
Practice Address - Country:US
Practice Address - Phone:818-980-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 5513103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist