Charles Burchell, PH D
Individual provider Active NPI Clinical Psychologist · Gretna, LA
NPI 1013008002 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1013008002
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 421 (LA)
- Practice address
- 1581 Carol Sue Ave
Suite 211
Gretna, LA 70056-5100 - Phone
- (504) 392-3498
- Fax
- (504) 392-4694
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240219002389 | LA | Practitioner - Clinical Psychologist | 4981003225 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Doctor on Demand Professionals P C | Current |
Accepting new patients | |
| Northlake Neurorehab Center | Past | Accepting new patients |
Locations
1 California St
Ste 2300
San Francisco, CA 94111
Phone (800) 929-0926
275 Battery St
Ste 650
San Francisco, CA 94111
Phone 4155043838104
501 Louisiana Ave
Baton Rouge, LA 70802
Phone 41550438389238
211 E 7th St
Ste 620
Austin, TX 78701
Phone (415) 742-8411
Interoperability endpoints
- charles.burchell.1@30520.direct.athenahealth.com
- https://api.platform.athenahealth.com/16704/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 421 | LA | Yes |
Addresses
Primary practice location
1581 Carol Sue Ave
Suite 211
Gretna, LA 70056-5100
Mailing address
1581 Carol Sue Ave
Suite 211
Gretna, LA 70056-5100
Phone (504) 392-3498
Other providers in Gretna, LA
- Naloni Bryant
- Denise Buffone
- Ngoc-Thuy Thi Bui
- Jordan Michael Buras
- Deregal Fay Burbank
- Shan-Coa Burke
- Trang Hoang Burke
- Vernance Patrice Burnett
- Duwanna Burse
- Daniel J Burst
All providers in Gretna, LA · Clinical Psychologist in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.