MEDICARE: DR. CHRIS C. CLATTERBUCK PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6301012073	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265498695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRIS C. CLATTERBUCK PHD

Provider Business Mailing Address
First Line	:	1714 WASHINGTON BLVD STE B
Second Line	:
City	:	BELPRE
State	:	OH
Zip	:	45714-2076
Country	:	US
Telephone Number	:	740-780-4010
Fax Number	:	740-780-4017

Provider Business Practice Location Address
First Line	:	1714 WASHINGTON BLVD STE B
Second Line	:
City	:	BELPRE
State	:	OH
Zip	:	45714-2076
Country	:	US
Telephone Number	:	740-780-4010
Fax Number	:	740-780-4017

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	05/20/2021

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