Provider Demographics
NPI:1528583960
Name:ROYSTON, CHARLES WHIPPO III (MS)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:WHIPPO
Last Name:ROYSTON
Suffix:III
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16691 BARTLETT LN APT 3
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-8550
Mailing Address - Country:US
Mailing Address - Phone:657-464-3128
Mailing Address - Fax:
Practice Address - Street 1:4199 CAMPUS DR STE 300
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2749
Practice Address - Country:US
Practice Address - Phone:949-502-4721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist