Provider Demographics
NPI:1184635823
Name:ANKUTA, GEORGE (PHD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:ANKUTA
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 1:16259 SYLVESTER RD SW
Mailing Address - Street 2:STE 504
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3059
Mailing Address - Country:US
Mailing Address - Phone:206-241-9068
Mailing Address - Fax:206-241-2651
Practice Address - Street 1:16259 SYLVESTER RD SW
Practice Address - Street 2:STE 504
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3059
Practice Address - Country:US
Practice Address - Phone:206-241-9068
Practice Address - Fax:206-241-2651
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1712103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA76834Medicaid
WA76834Medicaid