Provider Demographics
NPI:1023235678
Name:BUGLE, CHUCK C (PHD)
Entity type:Individual
Prefix:MR
First Name:CHUCK
Middle Name:C
Last Name:BUGLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 W. SPRING ST.
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906
Mailing Address - Country:US
Mailing Address - Phone:618-353-7180
Mailing Address - Fax:
Practice Address - Street 1:311 W. SPRING ST.
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906
Practice Address - Country:US
Practice Address - Phone:618-353-7180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities