Provider Demographics
NPI:1275873382
Name:GEORGE, ASHA ELIS (MC, LPC)
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:ELIS
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BARZONA BND
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7745
Mailing Address - Country:US
Mailing Address - Phone:512-484-7601
Mailing Address - Fax:
Practice Address - Street 1:13740 RESEARCH BLVD STE U4
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1841
Practice Address - Country:US
Practice Address - Phone:512-484-7601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65926101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional