Provider Demographics
NPI:1730394321
Name:HENDRIX, CHARLES C (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:C
Last Name:HENDRIX
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 HUMAN ENVIRON SCIENCES
Mailing Address - Street 2:OKLAHOMA STATE UNIVERSITY
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74078-6120
Mailing Address - Country:US
Mailing Address - Phone:405-744-8359
Mailing Address - Fax:405-744-2800
Practice Address - Street 1:1801 N WILDWOOD DR
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-3737
Practice Address - Country:US
Practice Address - Phone:405-744-8359
Practice Address - Fax:405-744-2800
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK078106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK078OtherLMFT