Provider Demographics
NPI:1033581723
Name:FIAGLE, CHRISTOPHER LEE
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:LEE
Last Name:FIAGLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 144575
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84114-4575
Mailing Address - Country:US
Mailing Address - Phone:385-468-4707
Mailing Address - Fax:385-468-4740
Practice Address - Street 1:2100 S STATE STREET
Practice Address - Street 2:S2-300
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84114-4575
Practice Address - Country:US
Practice Address - Phone:385-468-4707
Practice Address - Fax:385-468-4740
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor