Provider Demographics
NPI:1154765972
Name:MCHUGH, TINA A (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:A
Last Name:MCHUGH
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 CRESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:CT
Mailing Address - Zip Code:06524-3219
Mailing Address - Country:US
Mailing Address - Phone:203-623-2926
Mailing Address - Fax:
Practice Address - Street 1:48 CRESTWOOD RD
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:CT
Practice Address - Zip Code:06524-3219
Practice Address - Country:US
Practice Address - Phone:203-623-2926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000835101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health