Provider Demographics
NPI:1417240425
Name:GEORGE, ROXANNE (PHD, LMFT, EMDR-C)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PHD, LMFT, EMDR-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SAN FRANCISCO RD UNIT 1769
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557-4071
Mailing Address - Country:US
Mailing Address - Phone:575-758-4270
Mailing Address - Fax:505-633-7620
Practice Address - Street 1:195A STATE RD 240
Practice Address - Street 2:
Practice Address - City:RANCHOS DE TAOS
Practice Address - State:NM
Practice Address - Zip Code:87557-7811
Practice Address - Country:US
Practice Address - Phone:575-758-4270
Practice Address - Fax:505-633-7620
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0185271106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist