Provider Demographics
NPI:1760064828
Name:GEORGE, SHALI ALICE (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SHALI
Middle Name:ALICE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 PECAN GRV
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-1429
Mailing Address - Country:US
Mailing Address - Phone:214-500-7386
Mailing Address - Fax:
Practice Address - Street 1:800 KIRNWOOD DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2000
Practice Address - Country:US
Practice Address - Phone:972-982-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1033044363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health