Provider Demographics
NPI:1922634377
Name:GEORGE CALASA LICENSED PROFESSIONAL CLINICAL COUNSELOR INC
Entity Type:Organization
Organization Name:GEORGE CALASA LICENSED PROFESSIONAL CLINICAL COUNSELOR INC
Other - Org Name:MISTY MOUNTAINS COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:CALASA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:805-850-3057
Mailing Address - Street 1:154 EL MONTE AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-1754
Mailing Address - Country:US
Mailing Address - Phone:805-850-3057
Mailing Address - Fax:805-980-4562
Practice Address - Street 1:16321 ASKIN DR # 6688
Practice Address - Street 2:
Practice Address - City:PINE MOUNTAIN CLUB
Practice Address - State:CA
Practice Address - Zip Code:93222-9900
Practice Address - Country:US
Practice Address - Phone:805-850-3057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-18
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1922634377Medicaid
CA1013369875OtherGEORGE CALASA, LPCC