Provider Demographics
NPI:1275025553
Name:HALLMARK, CHARLES GABRIEL
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:GABRIEL
Last Name:HALLMARK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 W T C JESTER BLVD APT 211
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-3263
Mailing Address - Country:US
Mailing Address - Phone:917-509-5103
Mailing Address - Fax:
Practice Address - Street 1:26010 OAK RIDGE DR STE 107
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-1972
Practice Address - Country:US
Practice Address - Phone:281-815-0899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-03
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities