1174681233 NPI number — DR. CHARLOTTE CLARKE HOUSTON PH.D.

Table of content: DR. CHARLOTTE CLARKE HOUSTON PH.D. (NPI 1174681233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174681233 NPI number — DR. CHARLOTTE CLARKE HOUSTON PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOUSTON
Provider First Name:
CHARLOTTE
Provider Middle Name:
CLARKE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174681233
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9663 TIERRA GRANDE ST
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92126-4568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-695-2243
Provider Business Mailing Address Fax Number:
619-238-5686

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9663 TIERRA GRANDE ST
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92126-4568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-695-2243
Provider Business Practice Location Address Fax Number:
619-238-5686
Provider Enumeration Date:
12/04/2006

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: 103T00000X , with the licence number:  PSY7406 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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