Provider Demographics
NPI:1770612723
Name:CLEMONS, CHARLES FREDERICK SR (LPC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:FREDERICK
Last Name:CLEMONS
Suffix:SR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10806 EAST HIGHWAY 29
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-2403
Mailing Address - Country:US
Mailing Address - Phone:512-217-9287
Mailing Address - Fax:512-233-6363
Practice Address - Street 1:1907 N LAMAR BLVD STE 354
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-4900
Practice Address - Country:US
Practice Address - Phone:512-217-9287
Practice Address - Fax:512-233-6363
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17321101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional