Provider Demographics
NPI:1083756233
Name:PUGEL, THOMAS (LMFT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:PUGEL
Suffix:
Gender:M
Credentials:LMFT
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 594
Mailing Address - Street 2:
Mailing Address - City:MYRTLE CREEK
Mailing Address - State:OR
Mailing Address - Zip Code:97457-0058
Mailing Address - Country:US
Mailing Address - Phone:541-897-8377
Mailing Address - Fax:541-897-8370
Practice Address - Street 1:119 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:MYRTLE CREEK
Practice Address - State:OR
Practice Address - Zip Code:97457-9138
Practice Address - Country:US
Practice Address - Phone:541-897-8377
Practice Address - Fax:541-897-8370
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1530106H00000X
CA37978106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist