Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 2-2200 | TX |
N | 103TC0700X | Clinical Psychologist | 2-2200 | TX |
N | 103TA0700X | Adult Development & Aging Psychologist | 2-2200 | TX |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 2-2200 | TX |
N | 103G00000X | Clinical Psychologist | 2-2200 | TX |
N | 103TC0700X | Clinical Psychologist | 2-2200 | TX |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 2-2200 | TX |
N | 103TE1100X | Exercise & Sports Psychologist | 2-2200 | TX |
N | 103TF0000X | Family Psychologist | 2-2200 | TX |
N | 103TH0004X | Health Psychologist | 2-2200 | TX |
N | 103TH0100X | Health Service | 2-2200 | TX |
NPI | 1114142585 |
---|---|
Provider Name | Dr. Edward Allison Charlesworth |
First Address | Houston, TX 77070-1339 |
Second Address | Houston, TX 77070-4429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 08/07/2007 |