Provider Demographics
NPI:1710217427
Name:EARLE, GUY EDWARD (LPC, CART)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:EDWARD
Last Name:EARLE
Suffix:
Gender:M
Credentials:LPC, CART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 CHESAPEAKE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6310
Mailing Address - Country:US
Mailing Address - Phone:817-988-7964
Mailing Address - Fax:817-453-1086
Practice Address - Street 1:1043 CHESAPEAKE DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6310
Practice Address - Country:US
Practice Address - Phone:817-453-1086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62537101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional