Provider Demographics
NPI:1881679454
Name:GEORGE, MARK ALAN (LMFT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:GEORGE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5272 S LEWIS AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6563
Mailing Address - Country:US
Mailing Address - Phone:918-219-7377
Mailing Address - Fax:
Practice Address - Street 1:5272 S LEWIS AVE STE 114
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6563
Practice Address - Country:US
Practice Address - Phone:918-219-7377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001484106H00000X
OK709106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist