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General NPI Number Information
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NPI Number | 1992461131
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Entity Type | Individual
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Provider Name | CHARLES D CLENDENNEN III LPC-S
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Gender | Male
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Dates
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Enumeration Date | 11/11/2021
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Last Update Date | 11/11/2021
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Provider Practice Location Address
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Address Line | 7102 RIMWOOD
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City | LIVE OAK
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State | TX
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Zip | 78233-4208
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Country | US
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Telephone | 210-488-1668
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Fax |
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Provider Business Mailing Address
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Address Line | 7102 RIMWOOD
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City | LIVE OAK
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State | TX
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Zip | 78233-4208
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Country | US
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Telephone | 210-488-1668
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 11742
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License Number State | TX
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