Provider Demographics
NPI:1871568394
Name:ARCHARD, CHARLTON LEWIS (MED, LPC)
Entity type:Individual
Prefix:MR
First Name:CHARLTON
Middle Name:LEWIS
Last Name:ARCHARD
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 SIMON CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-3170
Mailing Address - Country:US
Mailing Address - Phone:915-587-6702
Mailing Address - Fax:
Practice Address - Street 1:654 SIMON CT
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-3170
Practice Address - Country:US
Practice Address - Phone:915-587-6702
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18339101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional