Provider Demographics
NPI:1811413487
Name:MCGEORGE, ZACHARY TYLER (MSW)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:TYLER
Last Name:MCGEORGE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 MARIE LANGDON DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-6329
Mailing Address - Country:US
Mailing Address - Phone:606-599-4080
Mailing Address - Fax:606-598-1688
Practice Address - Street 1:56 MARIE LANGDON DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-6329
Practice Address - Country:US
Practice Address - Phone:606-599-4080
Practice Address - Fax:606-598-1688
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
KY2553351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health