Provider Demographics
NPI:1336212208
Name:MECOUCH, GEORGE HARPER (DO)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:HARPER
Last Name:MECOUCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S ASH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-1789
Mailing Address - Country:US
Mailing Address - Phone:541-904-4030
Mailing Address - Fax:541-904-4006
Practice Address - Street 1:220 S ASH ST STE 1
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-1789
Practice Address - Country:US
Practice Address - Phone:541-904-4030
Practice Address - Fax:541-904-4006
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000012722084P0800X
ORDO1698502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty