Provider Demographics
NPI:1568533024
Name:BERRY, GEORGE CHRISTOPHER (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:CHRISTOPHER
Last Name:BERRY
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:PO BOX 1154
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-5154
Mailing Address - Country:US
Mailing Address - Phone:480-982-2356
Mailing Address - Fax:480-982-2449
Practice Address - Street 1:288 N IRONWOOD DR
Practice Address - Street 2:SUITE 110
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85220-3830
Practice Address - Country:US
Practice Address - Phone:480-982-2356
Practice Address - Fax:480-982-2449
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3459103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical