Provider Demographics
NPI:1053147264
Name:PUGH, VICTORIA G
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:G
Last Name:PUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W TAMAROA RD
Mailing Address - Street 2:
Mailing Address - City:INA
Mailing Address - State:IL
Mailing Address - Zip Code:62846-1200
Mailing Address - Country:US
Mailing Address - Phone:618-214-3320
Mailing Address - Fax:
Practice Address - Street 1:1790 NATIONS DR STE 110
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-9175
Practice Address - Country:US
Practice Address - Phone:618-288-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health