Provider Demographics
NPI:1942242037
Name:DALTON, CHARLES H (PHD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:H
Last Name:DALTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12012 WICKCHESTER LN
Mailing Address - Street 2:SUITE 550
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-1229
Mailing Address - Country:US
Mailing Address - Phone:832-448-2800
Mailing Address - Fax:832-448-2801
Practice Address - Street 1:12012 WICKCHESTER LN
Practice Address - Street 2:SUITE 550
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1229
Practice Address - Country:US
Practice Address - Phone:832-448-2800
Practice Address - Fax:832-448-2801
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25358103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041075502Medicaid
TX83149POtherBCBS
TX83153POtherBCBS
TX680014099OtherRAILROAD
TX041075503Medicaid
TX041075502Medicaid
TX83149PMedicare ID - Type Unspecified
TX83153POtherBCBS
TX041075503Medicaid