Provider Demographics
NPI:1013735323
Name:DOUGLAS WENDT COUNSELING LLC
Entity type:Organization
Organization Name:DOUGLAS WENDT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:TANNER
Authorized Official - Middle Name:
Authorized Official - Last Name:MOFFAT
Authorized Official - Suffix:
Authorized Official - Credentials:CSW
Authorized Official - Phone:442-207-8625
Mailing Address - Street 1:1869 N 1120 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-1180
Mailing Address - Country:US
Mailing Address - Phone:385-273-7250
Mailing Address - Fax:
Practice Address - Street 1:1869 N 1120 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1180
Practice Address - Country:US
Practice Address - Phone:385-273-7250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty