Provider Demographics
NPI:1316095441
Name:MCDOW, CHARLES D (MA)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:D
Last Name:MCDOW
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8109 GLADYS AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-8202
Mailing Address - Country:US
Mailing Address - Phone:409-860-9397
Mailing Address - Fax:409-860-0223
Practice Address - Street 1:8109 GLADYS AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-8202
Practice Address - Country:US
Practice Address - Phone:409-860-9397
Practice Address - Fax:409-860-0223
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11251101YM0800X
TX3326106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist