Provider Demographics
NPI:1215278254
Name:SUGUTURAGA, STANLEY LEONE JR (CSW)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:LEONE
Last Name:SUGUTURAGA
Suffix:JR
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 S. 522 W.
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-5311
Mailing Address - Country:US
Mailing Address - Phone:801-765-8817
Mailing Address - Fax:
Practice Address - Street 1:165 S. 522 W.
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5311
Practice Address - Country:US
Practice Address - Phone:801-765-8817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8007001-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical