Provider Demographics
NPI:1720205248
Name:THOMAS, CHARLES GARREL (MA, LPC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:GARREL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 QUAKER DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-4018
Mailing Address - Country:US
Mailing Address - Phone:281-703-6915
Mailing Address - Fax:
Practice Address - Street 1:1110 NASA PKWY STE 315
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3345
Practice Address - Country:US
Practice Address - Phone:281-703-6915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12964101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional