Provider Demographics
NPI:1255813044
Name:ST.GEORGE, AARON ELIAS (BS, CADC)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:ELIAS
Last Name:ST.GEORGE
Suffix:
Gender:M
Credentials:BS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 CLEVELAND BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4080
Mailing Address - Country:US
Mailing Address - Phone:208-800-0588
Mailing Address - Fax:208-800-0599
Practice Address - Street 1:524 CLEVELAND BLVD STE 230
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4080
Practice Address - Country:US
Practice Address - Phone:208-800-0588
Practice Address - Fax:208-800-0599
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID11542101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID11542OtherIBADCC