Healthcare Provider Details

I. General information

NPI: 1144509761
Provider Name (Legal Business Name): DOUGLAS MICHAEL HUSTON APC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 08/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1358 W BUSINESS PARK DR
OREM UT
84058-2203
US

IV. Provider business mailing address

1358 W BUSINESS PARK DR
OREM UT
84058-2203
US

V. Phone/Fax

Practice location:
  • Phone: 801-373-1197
  • Fax:
Mailing address:
  • Phone: 801-373-1197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7729022-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: