Provider Demographics
NPI:1194105866
Name:NEILL, CHARLES (LPC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:NEILL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9504 N IH 35
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-6613
Mailing Address - Country:US
Mailing Address - Phone:210-650-0422
Mailing Address - Fax:210-650-0169
Practice Address - Street 1:9504 N IH 35
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-6613
Practice Address - Country:US
Practice Address - Phone:210-650-0422
Practice Address - Fax:210-650-0169
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67444101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health