1174625883 NPI number — MS. CHARLA HUGHES CLARK MA, LMFT

Table of content: MS. CHARLA HUGHES CLARK MA, LMFT (NPI 1174625883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174625883 NPI number — MS. CHARLA HUGHES CLARK MA, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLARK
Provider First Name:
CHARLA
Provider Middle Name:
HUGHES
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLARK
Provider Other First Name:
CHARLA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, LMFT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1174625883
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7822 NORTHWOODS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77479-6429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-906-9930
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14780 MEMORIAL DR
Provider Second Line Business Practice Location Address:
STE. 206
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77079-5284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-906-9930
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  5042 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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