Provider Demographics
NPI:1972979763
Name:BELL, CHARLENE (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:
Last Name:BELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8128 S 107TH EAST AVE APT G
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5739
Mailing Address - Country:US
Mailing Address - Phone:650-815-1484
Mailing Address - Fax:
Practice Address - Street 1:2600 S EL CAMINO REAL
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2380
Practice Address - Country:US
Practice Address - Phone:650-578-8691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-15
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP03083103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical