Provider Demographics
NPI:1992025928
Name:GEORGE, CHRISTOPHER ALAN
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ALAN
Last Name:GEORGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 HEDGEAPPLE RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:MO
Mailing Address - Zip Code:65754-9216
Mailing Address - Country:US
Mailing Address - Phone:417-587-3355
Mailing Address - Fax:
Practice Address - Street 1:123 HEDGE APPLE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:MO
Practice Address - Zip Code:65754
Practice Address - Country:US
Practice Address - Phone:417-587-3355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010015160101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional