Provider Demographics
NPI:1730293499
Name:GEORGE, RICHARD ALLAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLAN
Last Name:GEORGE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11074 OYSTER RD
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601
Mailing Address - Country:US
Mailing Address - Phone:330-823-3072
Mailing Address - Fax:
Practice Address - Street 1:3118 CLEVELAND AVE NW
Practice Address - Street 2:RICHARD A GEORGE, PHD, INC.
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-2813
Practice Address - Country:US
Practice Address - Phone:330-492-9913
Practice Address - Fax:330-492-6561
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0000953101Y00000X
OH2871103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0417230Medicaid
OH0417230Medicaid