Provider Demographics
NPI:1386967396
Name:GEORGE, MAX (LCSW)
Entity type:Individual
Prefix:MR
First Name:MAX
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 BROADWAY ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-5342
Mailing Address - Country:US
Mailing Address - Phone:530-680-9735
Mailing Address - Fax:
Practice Address - Street 1:341 BROADWAY ST
Practice Address - Street 2:SUITE 207
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-5342
Practice Address - Country:US
Practice Address - Phone:530-680-9735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical