Provider Demographics
NPI:1306950316
Name:KLUGE, CHARLES ALFRED (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ALFRED
Last Name:KLUGE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:SUITE C-865
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2505
Mailing Address - Country:US
Mailing Address - Phone:972-566-7969
Mailing Address - Fax:972-566-6239
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE C-865
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:972-566-7969
Practice Address - Fax:972-566-6239
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21322103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00AF88Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST