Provider Demographics
NPI:1205892668
Name:BLUTH, GEORGE JOSEPH (PHD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JOSEPH
Last Name:BLUTH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 E CAMELBACK RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2617
Mailing Address - Country:US
Mailing Address - Phone:602-468-6996
Mailing Address - Fax:602-368-9413
Practice Address - Street 1:3930 E CAMELBACK RD
Practice Address - Street 2:SUITE 205
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2617
Practice Address - Country:US
Practice Address - Phone:602-468-6996
Practice Address - Fax:602-368-9413
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3121103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPHD3121Medicare ID - Type Unspecified