Provider Demographics
NPI:1598737868
Name:PUGH, CHARLES LANGSTON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:LANGSTON
Last Name:PUGH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:CHUCK
Other - Middle Name:
Other - Last Name:PUGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4404 YORK ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-4014
Mailing Address - Country:US
Mailing Address - Phone:940-691-2883
Mailing Address - Fax:940-767-4313
Practice Address - Street 1:900 8TH ST
Practice Address - Street 2:SUITE 716
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-6801
Practice Address - Country:US
Practice Address - Phone:940-767-4303
Practice Address - Fax:940-767-4313
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1236101YA0400X
TX9278101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSW00S51GOMedicaid
TXS516Medicare ID - Type Unspecified