Provider Demographics
NPI:1194057067
Name:BRAUCHLE, CHARLOTTE A (PHD, LPC, BCC, NCC)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:A
Last Name:BRAUCHLE
Suffix:
Gender:F
Credentials:PHD, LPC, BCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 W SUNSET RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2632
Mailing Address - Country:US
Mailing Address - Phone:210-495-8888
Mailing Address - Fax:210-495-8887
Practice Address - Street 1:143 W SUNSET RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2632
Practice Address - Country:US
Practice Address - Phone:210-495-8888
Practice Address - Fax:210-495-8887
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96110101Y00000X
TX19238101YP2500X
TX254643163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No163W00000XNursing Service ProvidersRegistered Nurse