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NPI Code Detail

MEDICARE: NATHAN WAGNER LPC

MEDICARE:   NATHAN  WAGNER  LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorPC007437PA

General Provider Information

NPI Number : 1336566140
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHAN WAGNER LPC
Provider Business Mailing Address
First Line : 344 S 13TH ST
Second Line :
City : HARRISBURG
State : PA
Zip : 17104-1777
Country : US
Telephone Number : 814-876-2938
Fax Number : 410-569-0094
Provider Business Practice Location Address
First Line : 251 VERBEKE ST
Second Line :
City : HARRISBURG
State : PA
Zip : 17102-2739
Country : US
Telephone Number : 814-876-2938
Fax Number : 410-569-0094
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2014
Last Update Date : 03/19/2014

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Directions to “ NATHAN WAGNER LPC” Practice Location

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