Provider Demographics
NPI:1033369509
Name:PEUGH, CHARLES BENJAMIN (MA, MFT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:BENJAMIN
Last Name:PEUGH
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1765
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:CA
Mailing Address - Zip Code:93644-1765
Mailing Address - Country:US
Mailing Address - Phone:559-760-1188
Mailing Address - Fax:
Practice Address - Street 1:49370 ROAD 426 STE B
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644-9052
Practice Address - Country:US
Practice Address - Phone:559-760-1188
Practice Address - Fax:559-641-2359
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC53131106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist