Provider Demographics
NPI:1730061607
Name:CRAGUN, CHARLES RHETT (LCSW)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:RHETT
Last Name:CRAGUN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5899 W RIVENDELL DR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-6500
Mailing Address - Country:US
Mailing Address - Phone:801-631-9531
Mailing Address - Fax:
Practice Address - Street 1:5899 W RIVENDELL DR
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-6500
Practice Address - Country:US
Practice Address - Phone:801-631-9531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5135079-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical