Provider Demographics
NPI:1740342153
Name:DAVIES, GEORGE RADER (MC)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:RADER
Last Name:DAVIES
Suffix:
Gender:M
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 NAKAI OVI
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-9644
Mailing Address - Country:US
Mailing Address - Phone:928-525-9648
Mailing Address - Fax:
Practice Address - Street 1:136 NAKAI OVI
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-9644
Practice Address - Country:US
Practice Address - Phone:928-525-9648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-0121101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health