Provider Demographics
NPI:1154344802
Name:CORDES, CHARLES BYRON (LMSW)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:BYRON
Last Name:CORDES
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14111 RED MAPLE WOOD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-1865
Mailing Address - Country:US
Mailing Address - Phone:210-479-1193
Mailing Address - Fax:
Practice Address - Street 1:14111 RED MAPLE WOOD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-1865
Practice Address - Country:US
Practice Address - Phone:210-479-1193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS26275104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker