Provider Demographics
NPI:1841979747
Name:YOUNGBLOOD, GEORGE WALKER (LCDC)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:WALKER
Last Name:YOUNGBLOOD
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9337B KATY FWY
Mailing Address - Street 2:PMB 314
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024
Mailing Address - Country:US
Mailing Address - Phone:713-464-3950
Mailing Address - Fax:
Practice Address - Street 1:11140 GREENBAY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-6729
Practice Address - Country:US
Practice Address - Phone:713-464-3950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)