Healthcare Provider Details

I. General information

NPI: 1326973629
Provider Name (Legal Business Name): AGUEDA HUBBARD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1399 S 700 E STE 15C
SALT LAKE CITY UT
84105-2149
US

IV. Provider business mailing address

1399 S 700 E STE 15C
SALT LAKE CITY UT
84105-2149
US

V. Phone/Fax

Practice location:
  • Phone: 801-828-5189
  • Fax:
Mailing address:
  • Phone: 801-828-5189
  • 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: MS. AGUEDA HUBBARD
Title or Position: OWNER
Credential: LCSW
Phone: 801-828-5189