Provider Demographics
NPI:1962052894
Name:HALE, CHARNELLE LATIA (BCBA)
Entity type:Individual
Prefix:
First Name:CHARNELLE
Middle Name:LATIA
Last Name:HALE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16441 SPACE CENTER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2015
Mailing Address - Country:US
Mailing Address - Phone:713-682-9660
Mailing Address - Fax:
Practice Address - Street 1:16441 SPACE CENTER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2015
Practice Address - Country:US
Practice Address - Phone:713-682-9660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2022-05-27
Deactivation Date:2022-04-19
Deactivation Code:
Reactivation Date:2022-05-24
Provider Licenses
StateLicense IDTaxonomies
TX5016103K00000X
TX16-20782106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician