| D. B. Tug Wagstaff, Lpc | |
|
1021 E 70 N American Fork UT 84003-2914 | |
| (801) 376-4787 | |
| Not Available |
| Full Name | D. B. Tug Wagstaff, Lpc |
|---|---|
| Speciality | Residential Treatment Facility, Intellectual And/or Developmental Disabilities |
| Location | 1021 E 70 N, American Fork, Utah |
| Authorized Official Name and Position | Doug 'tug' B. Wagstaff (OWNER) |
| Authorized Official Contact | 8013764787 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| D. B. Tug Wagstaff, Lpc 1021 E 70 N American Fork UT 84003-2914 Ph: (801) 376-4787 | D. B. Tug Wagstaff, Lpc 1021 E 70 N American Fork UT 84003-2914 Ph: (801) 376-4787 |
| NPI Number | 1053638031 |
|---|---|
| Provider Enumeration Date | 04/29/2010 |
| Last Update Date | 12/12/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053638031 | NPI | - | NPPES |
| 321749-6004 | Other | UT | PROFESSIONAL COUNSELOR LICENSE ISSUED BY STATE OF UTAH DEPT. OF COMMERCE |
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