Provider Demographics
NPI:1588004014
Name:DR. GEORGE ATHEY, PH.D., LLC
Entity Type:Organization
Organization Name:DR. GEORGE ATHEY, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:IVEY
Authorized Official - Last Name:ATHEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:785-640-8149
Mailing Address - Street 1:2201 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611-1975
Mailing Address - Country:US
Mailing Address - Phone:785-640-8149
Mailing Address - Fax:785-266-6546
Practice Address - Street 1:2201 SW 29TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-1975
Practice Address - Country:US
Practice Address - Phone:785-640-8149
Practice Address - Fax:785-266-6546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS311103G00000X, 103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS119657ATMedicare UPIN