Provider Demographics
NPI:1316356512
Name:WEATHERLOW, CHARLENE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:
Last Name:WEATHERLOW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 S 31ST ST
Mailing Address - Street 2:MS-20-D532
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76508-0001
Mailing Address - Country:US
Mailing Address - Phone:254-724-7859
Mailing Address - Fax:254-724-5240
Practice Address - Street 1:2401 S 31ST ST
Practice Address - Street 2:MS-20-D532
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508-0001
Practice Address - Country:US
Practice Address - Phone:254-724-7859
Practice Address - Fax:254-724-5240
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX552001041C0700X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No282N00000XHospitalsGeneral Acute Care Hospital