Doctor Name: | JEANETTE W GEORGEN |
NPI Number: | 1124065602 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, LCPC, ATR |
License Number: | |
Business Practice Address: | 10314 Lincoln Trl Suite 101 Fairview Heights, IL - 622081801 |
Business Phone Number: | 6183948952 |
Business Fax Number: | 6183948952 |
Mailing Address: | 10314 Lincoln Trl, Suite 101 FAIRVIEW HEIGHTS |
State: | IL |
Postal Code: | 622081801 |
Phone Number: | 6183948952 |
Fax Number: | 6183948952 |
NPI Enumeration Date: | 06/01/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |