Provider Demographics
NPI:1417145004
Name:GEORGE, MARY BETH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY BETH
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 TIMBER SHADOWS DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2041
Mailing Address - Country:US
Mailing Address - Phone:281-883-2749
Mailing Address - Fax:
Practice Address - Street 1:2330 TIMBER SHADOWS DR
Practice Address - Street 2:SUITE 106
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2041
Practice Address - Country:US
Practice Address - Phone:281-883-2749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62158101YP2500X
TXDT03103133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered