Provider Demographics
NPI:1518330554
Name:EARLE
Entity type:Organization
Organization Name:EARLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:EARLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:855-553-2783
Mailing Address - Street 1:1101 W 34TH ST STE 256
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1907
Mailing Address - Country:US
Mailing Address - Phone:855-553-2753
Mailing Address - Fax:855-553-2753
Practice Address - Street 1:4100 AVENUE D
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751
Practice Address - Country:US
Practice Address - Phone:855-553-2783
Practice Address - Fax:855-553-2783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty