Teresa Marie George, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY16121 Issued in CA

Practice address

3925 Imel Rd
San Luis Obispo, CA 93401-6238

Phone

(805) 710-3199

Fax

(805) 262-6206

NPI assigned

May 17, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646006400000",
    "number": "1619929445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3940-7 BROAD STREET, PMB #305",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "93401",
            "telephone_number": "805-971-0131",
            "fax_number": "805-926-2162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3925 IMEL RD",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934016238",
            "telephone_number": "805-710-3199",
            "fax_number": "805-262-6206"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10333 El Camino Real",
            "address_purpose": "LOCATION",
            "city": "Atascadero",
            "state": "CA",
            "postal_code": "934237001",
            "country_code": "US",
            "telephone_number": "805-468-2000",
            "fax_number": "805-466-6011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GEORGE",
        "first_name": "TERESA",
        "middle_name": "MARIE",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-17",
        "last_updated": "2022-02-28",
        "certification_date": "2022-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "CA",
            "license": "PSY16121",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY16121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Geoffey L Kamen MD a Professional Corporation
• Anthony Mark George
• Paul F Georghio, MD
• Michael Hanford Gerber, PH.D.
• Mardi A. Geredes, MA, RRW
• Kenneth Howard Germanow, PH.D.
• Joel Alan Germond, PSY.D.

• Clinical Psychologist in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.