DOUGLAS RAY WIESE

LOGAN, UT
NPI1558577700
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: UT  360651-6006)
Enumeration Date2007-05-15
Last Update Date2007-07-08
Business Address
-- DOUGLAS RAY WIESE
655 E 1300 N
LOGAN, UT 84341
Phone number: 435-792-6500
Mailing Address
-- DOUGLAS RAY WIESE
655 E 1300 N
LOGAN, UT 84341
Phone number: 435-792-6500
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