Provider Demographics
NPI:1700082872
Name:RUGGS, CLIFTON JUNIOR III (DMIN, LPC, CASAC)
Entity Type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:JUNIOR
Last Name:RUGGS
Suffix:III
Gender:M
Credentials:DMIN, LPC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S BATES ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-2146
Mailing Address - Country:US
Mailing Address - Phone:573-774-5894
Mailing Address - Fax:573-774-6975
Practice Address - Street 1:100 S BATES ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-2146
Practice Address - Country:US
Practice Address - Phone:573-774-5894
Practice Address - Fax:573-774-6975
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002680101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional