Provider Demographics
NPI:1932128675
Name:TUGGLE, CHARLES BARRY (MFT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:BARRY
Last Name:TUGGLE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:MR
Other - First Name:C.
Other - Middle Name:BARRY
Other - Last Name:TUGGLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:603 W F ST
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3734
Mailing Address - Country:US
Mailing Address - Phone:209-577-8400
Mailing Address - Fax:209-848-8825
Practice Address - Street 1:603 W F ST
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3734
Practice Address - Country:US
Practice Address - Phone:209-577-8400
Practice Address - Fax:209-848-8825
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29317106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist