Basic Information
| Provider Information | |||||||||
| NPI: | 1629390398 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARLES T BISBEE PHD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4022 QUIET GLADE CT | ||||||||
| Address2: | |||||||||
| City: | KINGWOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773451248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812529993 | ||||||||
| FaxNumber: | 2812529997 | ||||||||
| Practice Location | |||||||||
| Address1: | 19002 MCKAY BLVD | ||||||||
| Address2: | |||||||||
| City: | HUMBLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773385701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813199577 | ||||||||
| FaxNumber: | 2814468022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2010 | ||||||||
| LastUpdateDate: | 11/24/2010 | ||||||||
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| AuthorizedOfficialLastName: | BISBEE | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 2812529993 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.