Provider Demographics
NPI:1528099892
Name:GEORGE, JOHN W (LCSW, SWL,)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:GEORGE
Suffix:
Gender:M
Credentials:LCSW, SWL,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1526
Mailing Address - Country:US
Mailing Address - Phone:574-722-5151
Mailing Address - Fax:574-739-1414
Practice Address - Street 1:1015 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1526
Practice Address - Country:US
Practice Address - Phone:574-722-5151
Practice Address - Fax:574-739-1414
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33000266A104100000X
IN35000286A106H00000X
IN34000629A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000184322OtherANTHEM
IN138835000OtherMAGELLAN BEHAVIORAL
IN138835000OtherMAGELLAN BEHAVIORAL
IN000000184322OtherANTHEM
IN000000184322OtherANTHEM