Provider Demographics
NPI:1386638492
Name:JOUMAS, GEORGE J (MA)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:J
Last Name:JOUMAS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 E SHEA BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3074
Mailing Address - Country:US
Mailing Address - Phone:602-392-2012
Mailing Address - Fax:602-494-1728
Practice Address - Street 1:4545 E SHEA BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3074
Practice Address - Country:US
Practice Address - Phone:602-392-2012
Practice Address - Fax:602-494-1728
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-0514101YP2500X
MI6301007556103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC-0514OtherAZ LICENSE PRO COUNSELOR