Provider Demographics
NPI:1235620691
Name:CHARIS PSYCHOLOGICAL SERVICES & CHRISTIAN COUNSELING, PLLC
Entity Type:Organization
Organization Name:CHARIS PSYCHOLOGICAL SERVICES & CHRISTIAN COUNSELING, PLLC
Other - Org Name:CHARIS COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:GAYE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:682-302-4597
Mailing Address - Street 1:1030 HWY 377 E
Mailing Address - Street 2:SUITE 110169
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048
Mailing Address - Country:US
Mailing Address - Phone:682-302-4597
Mailing Address - Fax:
Practice Address - Street 1:1100 FM 56
Practice Address - Street 2:
Practice Address - City:GLEN ROSE
Practice Address - State:TX
Practice Address - Zip Code:76043
Practice Address - Country:US
Practice Address - Phone:682-302-4597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX374452601Medicaid