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NPI Code Detail

MEDICARE: CHARLES BREWSTER LCDC

MEDICARE: CHARLES BREWSTER LCDC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor10374TX

General Provider Information

NPI Number : 1912459843
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES BREWSTER LCDC
Provider Business Mailing Address
First Line : 202 PALMVIEW DR STE 3-C
Second Line :
City : PALMVIEW
State : TX
Zip : 78572-9394
Country : US
Telephone Number : 956-331-3234
Fax Number :
Provider Business Practice Location Address
First Line : 202 PALMVIEW DR STE 3-C
Second Line :
City : PALMVIEW
State : TX
Zip : 78572-9394
Country : US
Telephone Number : 956-331-3234
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2016
Last Update Date : 10/26/2016

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Directions to “ CHARLES BREWSTER LCDC” Practice Location

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