| Doctor Name: | CHARLTON THIEDE |
| NPI Number: | 1013296300 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LAC |
| License Number: | A1504056 |
| Business Practice Address: | 403 S Poplar St Suite A Searcy, AR - 721436017 |
| Business Phone Number: | 5012799220 |
| Business Fax Number: | 5012799450 |
| Mailing Address: | 403 S Poplar St, Suite A SEARCY |
| State: | AR |
| Postal Code: | 721436017 |
| Phone Number: | 5012799220 |
| Fax Number: | 5012799450 |
| NPI Enumeration Date: | 08/04/2011 |
| NPI Last Update Date: | 03/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | A1504056 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |