Provider Demographics
NPI:1811343387
Name:MARSH, CHARLOTTE (LMFT)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:MARSH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4726 OLD JACKSBORO HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-3500
Mailing Address - Country:US
Mailing Address - Phone:940-257-9044
Mailing Address - Fax:
Practice Address - Street 1:4726 OLD JACKSBORO HWY
Practice Address - Street 2:SUITE A
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76302-3500
Practice Address - Country:US
Practice Address - Phone:940-257-9044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202153106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist