Provider Demographics
NPI:1225068794
Name:NETHERTON, GEORGE THOMAS (LPC LPE LADAC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:THOMAS
Last Name:NETHERTON
Suffix:
Gender:M
Credentials:LPC LPE LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 DADDYS CREEK LANE
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-1569
Mailing Address - Country:US
Mailing Address - Phone:931-707-8921
Mailing Address - Fax:931-707-8921
Practice Address - Street 1:261 YVONNE AVENUE
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-1569
Practice Address - Country:US
Practice Address - Phone:931-707-8921
Practice Address - Fax:931-707-8921
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC00735101YP2500X
TNPE011566103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional