Provider Demographics
NPI:1780775916
Name:LIND, CHARLES ROD (NCC, LPC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ROD
Last Name:LIND
Suffix:
Gender:M
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6090 SURETY DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2061
Mailing Address - Country:US
Mailing Address - Phone:915-474-1222
Mailing Address - Fax:915-778-1770
Practice Address - Street 1:6090 SURETY DR
Practice Address - Street 2:SUITE 103
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2061
Practice Address - Country:US
Practice Address - Phone:915-474-1222
Practice Address - Fax:915-778-1770
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12480101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3556LCOtherBXBS