Provider Demographics
NPI:1972892933
Name:MCCLUGGAGE, NATALIE R (PHD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:R
Last Name:MCCLUGGAGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:JILL
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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:
Mailing Address - Fax:
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
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0143101YM0800X
KYKY-1775103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health