Healthcare Provider Details

I. General information

NPI: 1912464397
Provider Name (Legal Business Name): ALICE DUGHI CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 E 4800 S
MURRAY UT
84107-5040
US

IV. Provider business mailing address

357 E WESTMINSTER AVE
SALT LAKE CITY UT
84115-2227
US

V. Phone/Fax

Practice location:
  • Phone: 801-262-5418
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: