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General NPI Number Information
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NPI Number | 1386242386
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Entity Type | Individual
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Provider Name | CHARLES EARL EVERETT III LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/12/2020
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Last Update Date | 10/12/2020
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Provider Practice Location Address
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Address Line | 2501 W WILLIAM CANNON DR
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City | AUSTIN
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State | TX
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Zip | 78745-5281
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Country | US
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Telephone | 512-344-9189
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Fax |
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Provider Business Mailing Address
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Address Line | 9009 GREAT HILLS TRL APT 2021
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City | AUSTIN
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State | TX
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Zip | 78759-7145
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Country | US
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Telephone | 512-669-6219
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 62189
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License Number State | TX
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