Provider Demographics
NPI:1477763811
Name:PILKINTON, GEORGE R (LCSW, LADC)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:R
Last Name:PILKINTON
Suffix:
Gender:M
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 451585
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74345-1585
Mailing Address - Country:US
Mailing Address - Phone:918-786-2930
Mailing Address - Fax:918-786-5985
Practice Address - Street 1:32300 S 625 RD
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74345-1585
Practice Address - Country:US
Practice Address - Phone:918-786-2930
Practice Address - Fax:918-786-5985
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK143101YA0400X
OK31951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical