Provider Demographics
NPI:1043509821
Name:POLISZUK, GEORGE (LMFT)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:POLISZUK
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 SW BEAVERTON HILLSDALE HWY STE 560
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4791
Mailing Address - Country:US
Mailing Address - Phone:503-568-1115
Mailing Address - Fax:866-856-8268
Practice Address - Street 1:10700 SW BEAVERTON HILLSDALE HWY STE 560
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4791
Practice Address - Country:US
Practice Address - Phone:503-568-1115
Practice Address - Fax:866-856-8268
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1313101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1043509821Medicaid
ORT1313OtherOREGON BOARD OF LICENSED PROFESSIONAL COUNSELORS