Provider Demographics
NPI:1770632374
Name:CHELETTE, CARL JAMES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:JAMES
Last Name:CHELETTE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 HIGHTIMBER DR
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-6824
Mailing Address - Country:US
Mailing Address - Phone:817-456-3223
Mailing Address - Fax:817-329-3956
Practice Address - Street 1:3530 HIGHTIMBER DR
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-6824
Practice Address - Country:US
Practice Address - Phone:817-456-3223
Practice Address - Fax:817-329-3956
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS315911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611947Medicare ID - Type Unspecified