Provider Demographics
NPI:1285614123
Name:MCCALLA, CHARLOTTE LYNN (LPC LMFT)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:LYNN
Last Name:MCCALLA
Suffix:
Gender:F
Credentials:LPC LMFT
Other - Prefix:MRS
Other - First Name:CHARLOTTE
Other - Middle Name:LYNN
Other - Last Name:MUNGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC LMFT
Mailing Address - Street 1:1150 DEVEREUX DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573
Mailing Address - Country:US
Mailing Address - Phone:281-332-8608
Mailing Address - Fax:281-332-5283
Practice Address - Street 1:1150 DEVEREUX DR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573
Practice Address - Country:US
Practice Address - Phone:281-332-8608
Practice Address - Fax:281-332-5283
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8678101Y00000X
TX000366000359106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83079LOtherBLUE CROSS BLUE SHIELD
TX10009098OtherAMERIGROUP