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General NPI Number Information
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NPI Number | 1770612723
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Entity Type | Individual
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Provider Name | CHARLES FREDERICK CLEMONS SR. L.P.C.
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1907 N LAMAR BLVD STE 354
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City | AUSTIN
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State | TX
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Zip | 78705-4900
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Country | US
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Telephone | 512-217-9287
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Fax | 512-233-6363
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Provider Business Mailing Address
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Address Line | 10806 EAST HIGHWAY 29
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City | GEORGETOWN
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State | TX
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Zip | 78626-2403
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Country | US
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Telephone | 512-217-9287
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Fax | 512-233-6363
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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 | 17321
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License Number State | TX
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