Provider Demographics
NPI:1144312596
Name:GEORGE, CATHY (MS)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 W B ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-3501
Mailing Address - Country:US
Mailing Address - Phone:479-880-2288
Mailing Address - Fax:479-890-0195
Practice Address - Street 1:911 W B ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-3501
Practice Address - Country:US
Practice Address - Phone:479-880-2288
Practice Address - Fax:479-890-0195
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0604E101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health