Provider Demographics
NPI:1558441931
Name:MEADOWS, GEORGIANA B (LPC, LMHC)
Entity Type:Individual
Prefix:
First Name:GEORGIANA
Middle Name:B
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:GEORGIANA
Other - Middle Name:G
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MC
Mailing Address - Street 1:2400 W DUNLAP AVE
Mailing Address - Street 2:SUITE #300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2817
Mailing Address - Country:US
Mailing Address - Phone:602-943-2999
Mailing Address - Fax:602-943-4284
Practice Address - Street 1:2400 W DUNLAP AVE
Practice Address - Street 2:SUITE #300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2817
Practice Address - Country:US
Practice Address - Phone:602-943-2999
Practice Address - Fax:602-943-4284
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 10240101YP2500X
IA00852101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0159608Medicaid
IA242712OtherMIDLANDS CHOICE
IA07466OtherWELLMARK BLUE CROSS/BLUE SHIELD
IA07466OtherWELLMARK BLUE CROSS/BLUE SHIELD