Provider Demographics
NPI:1588312250
Name:FEARON, CHARVELA
Entity type:Individual
Prefix:
First Name:CHARVELA
Middle Name:
Last Name:FEARON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18019 BERRY BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-6748
Mailing Address - Country:US
Mailing Address - Phone:832-743-5944
Mailing Address - Fax:
Practice Address - Street 1:18019 BERRY BRANCH DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-6748
Practice Address - Country:US
Practice Address - Phone:832-743-5944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84367101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional