Provider Demographics
NPI:1215034632
Name:BRADY, CHARLES PATRICK (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PATRICK
Last Name:BRADY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3767 DURNESS WAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-2401
Mailing Address - Country:US
Mailing Address - Phone:713-664-3791
Mailing Address - Fax:713-664-0728
Practice Address - Street 1:2211 NORFOLK ST
Practice Address - Street 2:SUITE 500
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-4048
Practice Address - Country:US
Practice Address - Phone:713-526-6085
Practice Address - Fax:713-522-7315
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21380103TC0700X
TX30322103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F2657Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
TX00W319Medicare ID - Type UnspecifiedGROUP NUMBER