Provider Demographics
NPI:1689984387
Name:KALLINGAL, GEORGE K (PHD (CLINICAL PSYC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:K
Last Name:KALLINGAL
Suffix:
Gender:M
Credentials:PHD (CLINICAL PSYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PEDRO AGUON
Mailing Address - Street 2:
Mailing Address - City:BARRIGADA
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:671-632-7500
Mailing Address - Fax:
Practice Address - Street 1:1201 ROUTE 16
Practice Address - Street 2:KALLINGAL'S MEDICAL CLINIC
Practice Address - City:BARRIGADA
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-632-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUCP-1103TC0700X
GUCP-01103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical