Provider Demographics
NPI:1992423263
Name:CLG BETA
Entity type:Organization
Organization Name:CLG BETA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HYPNOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LUDWIG
Authorized Official - Middle Name:
Authorized Official - Last Name:AGURTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-928-4111
Mailing Address - Street 1:5151 S 900 E
Mailing Address - Street 2:SUITE 260
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117
Mailing Address - Country:US
Mailing Address - Phone:801-671-4357
Mailing Address - Fax:385-388-8305
Practice Address - Street 1:5151 S 900 E
Practice Address - Street 2:SUITE 260
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84117
Practice Address - Country:US
Practice Address - Phone:801-671-4357
Practice Address - Fax:385-388-8305
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLG BETA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No175L00000XOther Service ProvidersHomeopathGroup - Multi-Specialty