Provider Demographics
NPI:1063464600
Name:PUGMIRE, NATALIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:
Last Name:PUGMIRE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W 700 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-2227
Mailing Address - Country:US
Mailing Address - Phone:888-949-4864
Mailing Address - Fax:
Practice Address - Street 1:550 W 700 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-2227
Practice Address - Country:US
Practice Address - Phone:801-537-7537
Practice Address - Fax:801-363-3140
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6041199-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT261QR0405XOtherSUBSTANCE ABUSE
UT261QR0405XOtherSUBSTANCE ABUSE