Provider Demographics
NPI:1356389480
Name:CLABOUGH, CHARLES GORDON (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:GORDON
Last Name:CLABOUGH
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 1:2120 CRESTMOOR RD
Mailing Address - Street 2:SUITE 3011
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2613
Mailing Address - Country:US
Mailing Address - Phone:615-269-5798
Mailing Address - Fax:
Practice Address - Street 1:2120 CRESTMOOR RD
Practice Address - Street 2:SUITE 3011
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2613
Practice Address - Country:US
Practice Address - Phone:615-269-5798
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1476103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling