Provider Demographics
NPI:1598983991
Name:ILES, GEORGE ROSS III (LPC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:ROSS
Last Name:ILES
Suffix:III
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 MAGNOLIA TRL
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-9277
Mailing Address - Country:US
Mailing Address - Phone:409-755-7241
Mailing Address - Fax:409-755-6581
Practice Address - Street 1:260 MAGNOLIA TRL
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:TX
Practice Address - Zip Code:77657-9277
Practice Address - Country:US
Practice Address - Phone:409-755-7241
Practice Address - Fax:409-755-6581
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4130101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional