Provider Demographics
NPI:1821535634
Name:GEORGE, SHAYEN A (MA,)
Entity type:Individual
Prefix:
First Name:SHAYEN
Middle Name:A
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 FOREST HILL DR
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-2181
Mailing Address - Country:US
Mailing Address - Phone:724-813-3193
Mailing Address - Fax:330-534-7657
Practice Address - Street 1:165 FOREST HILL DR
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-2181
Practice Address - Country:US
Practice Address - Phone:724-813-3193
Practice Address - Fax:330-534-7657
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0001543101YM0800X
PAPS002965L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist