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1558577700
DOUGLAS RAY WIESE
LOGAN, UT
NPI
1558577700
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: UT 360651-6006)
Enumeration Date
2007-05-15
Last Update Date
2007-07-08
Business Address
-- DOUGLAS RAY WIESE
655 E 1300 N
LOGAN, UT 84341
Phone number: 435-792-6500
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Mailing Address
-- DOUGLAS RAY WIESE
655 E 1300 N
LOGAN, UT 84341
Phone number: 435-792-6500
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