Healthcare Provider Details

I. General information

NPI: 1083756233
Provider Name (Legal Business Name): THOMAS PUGEL LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 NW 2ND AVE
MYRTLE CREEK OR
97457-9138
US

IV. Provider business mailing address

PO BOX 594
MYRTLE CREEK OR
97457-0058
US

V. Phone/Fax

Practice location:
  • Phone: 541-897-8377
  • Fax: 541-897-8370
Mailing address:
  • Phone: 541-897-8377
  • Fax: 541-897-8370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT1530
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number37978
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: