Provider Demographics
NPI:1487008926
Name:OTURA, GEORGE O (LPC, LMHC)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:O
Last Name:OTURA
Suffix:
Gender:M
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6723 5TH CT SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-7918
Mailing Address - Country:US
Mailing Address - Phone:269-220-2285
Mailing Address - Fax:
Practice Address - Street 1:6723 5TH CT SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-7918
Practice Address - Country:US
Practice Address - Phone:269-220-2285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61438271101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health