Provider Demographics
NPI:1689769184
Name:CHARLES, CLIFTON EARL (MA)
Entity Type:Individual
Prefix:MR
First Name:CLIFTON
Middle Name:EARL
Last Name:CHARLES
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 BREWSTER LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1773
Mailing Address - Country:US
Mailing Address - Phone:832-721-7524
Mailing Address - Fax:832-415-2472
Practice Address - Street 1:435 MURPHY RD STE B1344
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5421
Practice Address - Country:US
Practice Address - Phone:832-440-0827
Practice Address - Fax:832-415-2472
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63569101YM0800X
TX101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1689769184OtherNPI
TX189923903Medicaid