Provider Demographics
NPI:1629390398
Name:CHARLES T BISBEE PHD LLC
Entity Type:Organization
Organization Name:CHARLES T BISBEE PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:T
Authorized Official - Last Name:BISBEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:281-252-9993
Mailing Address - Street 1:4022 QUIET GLADE CT
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-1248
Mailing Address - Country:US
Mailing Address - Phone:281-252-9993
Mailing Address - Fax:281-252-9997
Practice Address - Street 1:19002 MCKAY BLVD
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5701
Practice Address - Country:US
Practice Address - Phone:281-319-9577
Practice Address - Fax:281-446-8022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB106770Medicare PIN