Provider Demographics
NPI:1437379849
Name:HIATT, CHARLES OWEN (LPC/MHSP)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:OWEN
Last Name:HIATT
Suffix:
Gender:M
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5819 WINDING LN
Mailing Address - Street 2:SUITE J
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3631
Mailing Address - Country:US
Mailing Address - Phone:423-933-2575
Mailing Address - Fax:423-285-6160
Practice Address - Street 1:5819 WINDING LN
Practice Address - Street 2:SUITE J
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3631
Practice Address - Country:US
Practice Address - Phone:423-933-2575
Practice Address - Fax:423-285-6160
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2709101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional