Provider Demographics
NPI:1609984723
Name:GEORGE, JEANNE L (PHD)
Entity Type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:L
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 QUAIL OAK DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9023
Mailing Address - Country:US
Mailing Address - Phone:225-769-1410
Mailing Address - Fax:225-768-2586
Practice Address - Street 1:2222 QUAIL RUN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808
Practice Address - Country:US
Practice Address - Phone:225-768-2584
Practice Address - Fax:225-768-2586
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA503103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
56151Medicare ID - Type Unspecified