Individual
CHARLES SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4118 BLOSSOM ST, HOUSTON, TX 77007-5711
(713) 863-8511
Mailing address
4118 BLOSSOM ST, HOUSTON, TX 77007-5711
(713) 863-8511
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
D8430
TX
Other
Enumeration date
03/26/2013
Last updated
03/26/2013
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