Provider Demographics
NPI:1992760466
Name:GEORGE, MATTHEW (LSCSW)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:GEORGE
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 RIVERVIEW ST
Mailing Address - Street 2:SUITE LL2
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4200
Mailing Address - Country:US
Mailing Address - Phone:316-262-5253
Mailing Address - Fax:316-262-7202
Practice Address - Street 1:345 RIVERVIEW ST
Practice Address - Street 2:SUITE LL2
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4200
Practice Address - Country:US
Practice Address - Phone:316-262-5253
Practice Address - Fax:316-262-7202
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS16101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical