Provider Demographics
NPI:1457716078
Name:HUGHES, JUSTIN GRANT (CWS, LSUDC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:GRANT
Last Name:HUGHES
Suffix:
Gender:M
Credentials:CWS, LSUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 MEADOWLARK RD
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-2368
Mailing Address - Country:US
Mailing Address - Phone:435-841-2735
Mailing Address - Fax:
Practice Address - Street 1:8072 S HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-5037
Practice Address - Country:US
Practice Address - Phone:801-455-2687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-25
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10946701-6006101YA0400X
UT10946701-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1457716078Medicaid