Provider Demographics
NPI:1730201658
Name:MIEARS, CHARLES ALAN (LPC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ALAN
Last Name:MIEARS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13740 N HIGHWAY 183
Mailing Address - Street 2:SUTIE H-1
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1884
Mailing Address - Country:US
Mailing Address - Phone:512-779-2903
Mailing Address - Fax:
Practice Address - Street 1:13740 N HIGHWAY 183
Practice Address - Street 2:SUTIE H-1
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1884
Practice Address - Country:US
Practice Address - Phone:512-779-2903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11253101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health