Provider Demographics
NPI:1700116035
Name:WEBBER, CHARLES EDWARD (MS,LPC,LADC,CANIDATE)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:EDWARD
Last Name:WEBBER
Suffix:
Gender:M
Credentials:MS,LPC,LADC,CANIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 SE LANCELOT LN
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-6392
Mailing Address - Country:US
Mailing Address - Phone:580-351-2763
Mailing Address - Fax:
Practice Address - Street 1:402 SE LANCELOT LN
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-6392
Practice Address - Country:US
Practice Address - Phone:580-351-2763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health