Provider Demographics
NPI:1871645382
Name:BLOUNT, GEORGE W JR (MSW LMHC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:W
Last Name:BLOUNT
Suffix:JR
Gender:M
Credentials:MSW LMHC
Other - Prefix:
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Mailing Address - Street 1:330 W LEXINGTON AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516
Mailing Address - Country:US
Mailing Address - Phone:574-293-5991
Mailing Address - Fax:574-293-5429
Practice Address - Street 1:108 N MAIN ST
Practice Address - Street 2:SUITE 500
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601
Practice Address - Country:US
Practice Address - Phone:574-246-1244
Practice Address - Fax:574-246-1250
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN39001415A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor