Individual provider Active NPI

Edward Allison Charlesworth, PHD

  • Clinical Neuropsychologist
  • Houston, TX
National Provider Identifier
1114142585
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
2-2200 Issued in TX
Practice address
10609 Grant Rd
Building B
Houston, TX 77070-4429
Phone
(281) 469-6395
NPI assigned
Apr 13, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 2-2200 TX Primary
Adult Development & Aging Psychologist 103TA0700X 2-2200 TX
Cognitive & Behavioral Psychologist 103TB0200X 2-2200 TX
Clinical Psychologist 103TC0700X 2-2200 TX
Clinical Child & Adolescent Psychologist 103TC2200X 2-2200 TX
Exercise & Sports Psychologist 103TE1100X 2-2200 TX
Family Psychologist 103TF0000X 2-2200 TX
Health Psychologist 103TH0004X 2-2200 TX
Health Service Psychologist 103TH0100X 2-2200 TX

Addresses

Primary practice location

10609 Grant Rd
Building B
Houston, TX 77070-4429

Mailing address

11407 Hylander Dr
Houston, TX 77070-1339
Phone (281) 469-6395

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141119001731 TX Practitioner - Clinical Psychologist 2769604115 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

10609 Grant Rd
Suite B
Houston, TX 77070-4462
Phone (281) 469-6395

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
2-2200TXMDClinical Psychologist
22200TXMDGeneral Practice Dentistry

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1114142585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11407 HYLANDER DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770701339",
            "telephone_number": "281-469-6395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10609 GRANT RD",
            "address_2": "BUILDING B",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770704429",
            "telephone_number": "281-469-6395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHARLESWORTH",
        "first_name": "EDWARD",
        "middle_name": "ALLISON",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-13",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "TX",
            "license": "2-2200",
            "primary": true
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "TX",
            "license": "2-2200",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "TX",
            "license": "2-2200",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "2-2200",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "TX",
            "license": "2-2200",
            "primary": false
        },
        {
            "code": "103TE1100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Exercise & Sports",
            "state": "TX",
            "license": "2-2200",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "TX",
            "license": "2-2200",
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "TX",
            "license": "2-2200",
            "primary": false
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "TX",
            "license": "2-2200",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.