Provider Demographics
NPI:1639288269
Name:COMPTON, GEORGE EDWIN JR (PH D)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:EDWIN
Last Name:COMPTON
Suffix:JR
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67782 KLINGER LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091
Mailing Address - Country:US
Mailing Address - Phone:269-651-6949
Mailing Address - Fax:269-651-3180
Practice Address - Street 1:10 VANS AVENUE
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036
Practice Address - Country:US
Practice Address - Phone:517-278-4741
Practice Address - Fax:269-651-3180
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011736103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist