Provider Demographics
NPI:1902535610
Name:GEORGILIS, PETER (LPC)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:GEORGILIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 E MAIN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-5220
Mailing Address - Country:US
Mailing Address - Phone:512-466-5891
Mailing Address - Fax:
Practice Address - Street 1:306 E MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-5220
Practice Address - Country:US
Practice Address - Phone:512-466-5891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86565101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional