Provider Demographics
NPI:1942290366
Name:WALLACE-BARNHILL, GEORGE L (PHD LMHC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:L
Last Name:WALLACE-BARNHILL
Suffix:
Gender:M
Credentials:PHD LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10315 SW 53RD ST
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328
Mailing Address - Country:US
Mailing Address - Phone:954-832-0998
Mailing Address - Fax:
Practice Address - Street 1:1323 SE 4TH AVE
Practice Address - Street 2:STE B16
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316
Practice Address - Country:US
Practice Address - Phone:954-832-0998
Practice Address - Fax:954-467-8439
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH000574101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health