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General NPI Number Information
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NPI Number | 1013296300
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Entity Type | Individual
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Provider Name | CHARLTON THIEDE LAC
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Gender | Male
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Dates
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Enumeration Date | 08/04/2011
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 106 S SPRING ST STE A
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City | SEARCY
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State | AR
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Zip | 72143-7717
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Country | US
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Telephone | 501-388-9694
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Fax |
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Provider Business Mailing Address
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Address Line | 403 S POPLAR ST SUITE A
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City | SEARCY
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State | AR
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Zip | 72143-6017
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Country | US
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Telephone | 501-279-9220
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Fax | 501-279-9450
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P1701224
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License Number State | AR
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