# D. B. TUG WAGSTAFF, LPC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053638031
- **Authorized official:** MR. DOUG 'TUG' B. WAGSTAFF M.ED., LPC (OWNER)
- **Authorized official phone:** (801) 376-4787

## Contact information

- **Practice address:** 1021 E 70 N, AMERICAN FORK, UT 84003-2914
- **Practice address phone:** (801) 376-4787
- **Mailing address:** 1021 E 70 N, AMERICAN FORK, UT 84003-2914
- **Mailing address phone:** (801) 376-4787

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 273R00000X | Psychiatric Hospital Unit | 321749-6004 | UT | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 321749-6004 | UT | Yes |

## Other

- **Enumeration date:** 04/29/2010
- **Last updated:** 12/12/2012