Provider Demographics
NPI:1063551042
Name:BOTBYL, GEORGE T (MA, LMSW)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:T
Last Name:BOTBYL
Suffix:
Gender:M
Credentials:MA, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7307 LAKE BLUFF
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MI
Mailing Address - Zip Code:49837
Mailing Address - Country:US
Mailing Address - Phone:906-428-4332
Mailing Address - Fax:
Practice Address - Street 1:1100 LUDINGTON ST
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-3542
Practice Address - Country:US
Practice Address - Phone:906-233-1554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801058201101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health