Provider Demographics
NPI:1336248913
Name:KAKKANATT, GEORGE M (LCSW)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:M
Last Name:KAKKANATT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14014 COBALT GLEN DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-2092
Mailing Address - Country:US
Mailing Address - Phone:281-723-8520
Mailing Address - Fax:
Practice Address - Street 1:14014 COBALT GLEN DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-2092
Practice Address - Country:US
Practice Address - Phone:281-723-8520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS294161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical