Healthcare Provider Details

I. General information

NPI: 1255783957
Provider Name (Legal Business Name): MATTHEW RYAN CLUGH MS, NCC, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 SHEELEY LN
BOILING SPRINGS PA
17007-9436
US

IV. Provider business mailing address

20 SHEELEY LN
BOILING SPRINGS PA
17007-9436
US

V. Phone/Fax

Practice location:
  • Phone: 717-422-4396
  • Fax:
Mailing address:
  • Phone: 717-422-4396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC011186
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: