Provider Demographics
NPI:1902215569
Name:MCCLUGGAGE CONSULTING LLC
Entity Type:Organization
Organization Name:MCCLUGGAGE CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLUGGAGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:502-797-0202
Mailing Address - Street 1:521 EVERGREEN PLACE CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2277
Mailing Address - Country:US
Mailing Address - Phone:502-797-0202
Mailing Address - Fax:502-253-5753
Practice Address - Street 1:521 EVERGREEN PLACE CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2277
Practice Address - Country:US
Practice Address - Phone:502-797-0202
Practice Address - Fax:502-253-5753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1775103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty