Provider Demographics
NPI:1518330554
Name:EARLE INC
Entity Type:Organization
Organization Name:EARLE INC
Other - Org Name:C. JASON EARLE, LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:EARLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:855-553-2783
Mailing Address - Street 1:PO BOX 4671
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78765-4671
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7703 N. LAMAR BLVD
Practice Address - Street 2:SUITE 225
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3529
Practice Address - Country:US
Practice Address - Phone:855-553-2783
Practice Address - Fax:855-553-2783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty