Provider Demographics
NPI:1689192510
Name:SMILEDGE, GEORGE (LPC - 6807)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:SMILEDGE
Suffix:
Gender:M
Credentials:LPC - 6807
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 N RAMSEY RD APT 108
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-1616
Mailing Address - Country:US
Mailing Address - Phone:208-518-6400
Mailing Address - Fax:208-216-7762
Practice Address - Street 1:8596 N WAYNE DR STE A
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-5068
Practice Address - Country:US
Practice Address - Phone:208-518-6400
Practice Address - Fax:208-216-7622
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6807101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health