Provider Demographics
NPI:1588049142
Name:CLUCHEY, CHARLES ADAM (LPC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ADAM
Last Name:CLUCHEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:ADAM
Other - Middle Name:
Other - Last Name:CLUCHEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:3939 W GREEN OAKS BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-2793
Mailing Address - Country:US
Mailing Address - Phone:214-608-0701
Mailing Address - Fax:
Practice Address - Street 1:3939 W GREEN OAKS BLVD STE 206
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-2793
Practice Address - Country:US
Practice Address - Phone:214-608-0701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70589101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional