Provider Demographics
NPI:1326806720
Name:CLAGUE, CHRISTOPHER JUSTIN (LMHC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JUSTIN
Last Name:CLAGUE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4916 DUNN RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-4270
Mailing Address - Country:US
Mailing Address - Phone:863-510-4350
Mailing Address - Fax:
Practice Address - Street 1:2725 HWY 60 E
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-8872
Practice Address - Country:US
Practice Address - Phone:863-533-4139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22968101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health