NPI 1053638031

D. B. Tug Wagstaff, Lpc

Organisation Intellectual and/or Developmental Disabilities Residential Treatment Facility American Fork, UT

Practice location

Address: 1021 E 70 N, American Fork, UT 84003-2914
Phone: (801) 376-4787

Authorised official

Name: Doug 'Tug' B. Wagstaff
Title: Owner
Phone: (801) 376-4787

Registered specialties (2)

Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320600000X Licence 321749-6004 (UT)

Other Residential Treatment Facility, Intellectual and/or Developmental Disabilities providers in Utah →

Psychiatric Hospital Unit

Hospital Units Taxonomy 273R00000X Licence 321749-6004 (UT)

Other Psychiatric Unit providers in Utah →

Registry record

NPI: 1053638031
Entity type: Organization
NPI issued: 29 Apr 2010
Record last updated: 12 Dec 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.