Provider Demographics
NPI:1437196193
Name:KATES, GEORGE H (PHD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:H
Last Name:KATES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36500 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3169
Mailing Address - Country:US
Mailing Address - Phone:248-489-9411
Mailing Address - Fax:
Practice Address - Street 1:36500 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3169
Practice Address - Country:US
Practice Address - Phone:248-489-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301000833103TC0700X
MI4101005074106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680F323920OtherBLUE CROSS MICHIGAN PIN
MI680F323920OtherBLUE CROSS MICHIGAN PIN
MI0P18620Medicare PIN