Provider Demographics
NPI:1821086398
Name:HOWARD, CHARLES A (PHD, ABPP-CL)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:HOWARD
Suffix:
Gender:M
Credentials:PHD, ABPP-CL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 35TH AVE
Mailing Address - Street 2:STE A #110
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3962
Mailing Address - Country:US
Mailing Address - Phone:970-315-1040
Mailing Address - Fax:970-339-4584
Practice Address - Street 1:2032 35TH AVE
Practice Address - Street 2:STE A, #110
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3962
Practice Address - Country:US
Practice Address - Phone:970-315-1040
Practice Address - Fax:970-339-4584
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY695103TC0700X
CO2124103TC2200X, 103TH0004X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO303902Medicare PIN
COR81679Medicare UPIN
CO803095Medicare ID - Type UnspecifiedTRANSITIONS PSYCHOLOGY
CO803094Medicare ID - Type UnspecifiedTRANSITIONS PG GROUP #
CO803095Medicare ID - Type UnspecifiedTRANSITIONS PSYCHOLOGY