MEDICARE: DR. CHARLES GORDON CLABOUGH PH.D.

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	103TC1900X	Counseling Psychologist	P1476	TN

General Provider Information

NPI Number	:	1356389480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES GORDON CLABOUGH PH.D.

Provider Business Mailing Address
First Line	:	2120 CRESTMOOR RD
Second Line	:	SUITE 3011
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2613
Country	:	US
Telephone Number	:	615-269-5798
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 CRESTMOOR RD
Second Line	:	SUITE 3011
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2613
Country	:	US
Telephone Number	:	615-269-5798
Fax Number	:

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	07/08/2007

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