Provider Demographics
NPI:1942960554
Name:MIDDLETON, GEORGE (MHC, CSAYC)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:MHC, CSAYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10679 GLENWYCK PL
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4881
Mailing Address - Country:US
Mailing Address - Phone:317-213-2741
Mailing Address - Fax:
Practice Address - Street 1:202 E MARKET ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-3306
Practice Address - Country:US
Practice Address - Phone:317-213-2741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health