Provider Demographics
NPI:1093106528
Name:ST GEORGE, JAHLEH MOHAMMADI (LMHC, RPT, CCPT)
Entity type:Individual
Prefix:MRS
First Name:JAHLEH
Middle Name:MOHAMMADI
Last Name:ST GEORGE
Suffix:
Gender:F
Credentials:LMHC, RPT, CCPT
Other - Prefix:
Other - First Name:JAHLEH
Other - Middle Name:
Other - Last Name:MOHAMMADI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1237 DUTCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:TULLY
Mailing Address - State:NY
Mailing Address - Zip Code:13159-3057
Mailing Address - Country:US
Mailing Address - Phone:315-289-2504
Mailing Address - Fax:
Practice Address - Street 1:1237 DUTCH HILL RD
Practice Address - Street 2:
Practice Address - City:TULLY
Practice Address - State:NY
Practice Address - Zip Code:13159-3057
Practice Address - Country:US
Practice Address - Phone:315-289-2504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health