Provider Demographics
NPI:1518248913
Name:PUGH, BOBBIE JEAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:JEAN
Last Name:PUGH
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 1:1165 E 300 N
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-3539
Mailing Address - Country:US
Mailing Address - Phone:801-852-3565
Mailing Address - Fax:801-852-3550
Practice Address - Street 1:1165 E 300 N
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-3539
Practice Address - Country:US
Practice Address - Phone:801-852-3565
Practice Address - Fax:801-852-3550
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8273383-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical