Provider Demographics
NPI:1366475667
Name:HYATT, GEORGE STEPHEN (LISW)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:STEPHEN
Last Name:HYATT
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HIGH ST STE 119
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-2709
Mailing Address - Country:US
Mailing Address - Phone:513-470-3691
Mailing Address - Fax:513-330-6730
Practice Address - Street 1:20 HIGH ST STE 119
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-2709
Practice Address - Country:US
Practice Address - Phone:513-470-3691
Practice Address - Fax:513-330-6730
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI07002101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000375495OtherANTHEM PIN