Provider Demographics
NPI:1235152257
Name:TARELL, CHARLOTTE MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:MARIE
Last Name:TARELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 SHOAL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1950
Mailing Address - Country:US
Mailing Address - Phone:972-363-0654
Mailing Address - Fax:
Practice Address - Street 1:2750 VIRGINIA PKWY STE 108
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-4970
Practice Address - Country:US
Practice Address - Phone:972-542-8144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC 65419101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL802008566Medicaid
TX1235152257OtherINSURANCE COMPANIES
TX1235152257OtherINSURANCE COMPANIES