Organization
D. B. TUG WAGSTAFF, LPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUG 'TUG' B. WAGSTAFF M.ED., LPC (OWNER)
(801) 376-4787
Entity
Organization
Contact information
Practice address
1021 E 70 N, AMERICAN FORK, UT 84003-2914
(801) 376-4787
Mailing address
1021 E 70 N, AMERICAN FORK, UT 84003-2914
(801) 376-4787
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
321749-6004
UT
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
321749-6004
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
321749-6004
PROFESSIONAL COUNSELOR LICENSE ISSUED BY STATE OF UTAH DEPT. OF COMMERCE
UT
Enumeration date
04/29/2010
Last updated
12/12/2012
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