| Doctor Name: | THOMAS L CHARLES |
| NPI Number: | 1265429260 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW, LCSW |
| License Number: | 4207-123 |
| Business Practice Address: | 108 E North St Friendship, WI - 539349443 |
| Business Phone Number: | 6083394511 |
| Business Fax Number: | 6083394593 |
| Mailing Address: | 108 E North St, FRIENDSHIP |
| State: | WI |
| Postal Code: | 539349443 |
| Phone Number: | 6083394511 |
| Fax Number: | 6083394593 |
| NPI Enumeration Date: | 10/04/2005 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 4207-123 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |