Individual
GEORGE MARSHALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1210 4TH ST, LEWISPORT, KY 42351-2526
(270) 295-6452
(270) 295-6450
Mailing address
1210 4TH ST, LEWISPORT, KY 42351-2526
(270) 295-6452
(270) 295-6450
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1636
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000175357
ANTHEM
KY
01
—
11574926
CAQH
—
01
—
263895
TRICARE
KY
05
—
30605018
—
KY
Enumeration date
06/05/2006
Last updated
03/24/2016
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