Individual
RAYMOND SAMUEL WAGSTAFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1937 S WYOMING ST, SALT LAKE CITY, UT 84108-3237
(801) 573-3213
Mailing address
1937 WYOMING ST, SALT LAKE CITY, UT 84108-3237
(801) 486-8635
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
8099256-6004
UT
Other
Enumeration date
10/22/2010
Last updated
02/18/2023
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