Provider Demographics
NPI:1003956194
Name:COMEAUX, GEORGE PAUL (LCSW)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:PAUL
Last Name:COMEAUX
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:GEORGE
Other - Middle Name:PAUL
Other - Last Name:COMEAUX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:8829 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-2610
Mailing Address - Country:US
Mailing Address - Phone:662-280-5758
Mailing Address - Fax:662-280-5708
Practice Address - Street 1:8829 CENTRE ST
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-2610
Practice Address - Country:US
Practice Address - Phone:662-280-5758
Practice Address - Fax:662-280-5708
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC70461041C0700X
TNLSW00000050561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical