Provider Demographics
NPI:1336367200
Name:PUGH, ROBERT L (LCSW, LMFT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:PUGH
Suffix:
Gender:M
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 POPLAR AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4433
Mailing Address - Country:US
Mailing Address - Phone:901-405-2007
Mailing Address - Fax:901-405-2008
Practice Address - Street 1:4646 POPLAR AVE STE 310
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4433
Practice Address - Country:US
Practice Address - Phone:901-405-2007
Practice Address - Fax:901-405-2008
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLCSW 791041C0700X
TNLMFT 20106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist