Provider Demographics
NPI:1164639340
Name:BEALS, GEORGE RAY (PHD LPC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:RAY
Last Name:BEALS
Suffix:
Gender:M
Credentials:PHD LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 MARTIN LUTHER KING DRIVE WEST
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759
Mailing Address - Country:US
Mailing Address - Phone:662-323-5588
Mailing Address - Fax:662-323-5588
Practice Address - Street 1:519 MARTIN LUTHER KING DR W
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759
Practice Address - Country:US
Practice Address - Phone:662-323-5588
Practice Address - Fax:662-323-5588
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0715101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional