Provider Demographics
NPI:1295173672
Name:EARLE, CHARLES JASON (LCSW)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JASON
Last Name:EARLE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:C.
Other - Middle Name:JASON
Other - Last Name:EARLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:4300 SPEEDWAY - UNIT 4671
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78765
Mailing Address - Country:US
Mailing Address - Phone:855-553-2753
Mailing Address - Fax:855-553-2753
Practice Address - Street 1:7703 N. LAMAR BLVD
Practice Address - Street 2:SUITE 225
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1131
Practice Address - Country:US
Practice Address - Phone:855-553-2753
Practice Address - Fax:855-553-2753
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX376981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical