Healthcare Provider Details

I. General information

NPI: 1043134885
Provider Name (Legal Business Name): NICHOLAS WEGMAN MA, T-LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 N NORTHSIGHT BLVD STE 110
SCOTTSDALE AZ
85260-3673
US

IV. Provider business mailing address

14545 N FRANK LLOYD WRIGHT BLVD UNIT 1061
SCOTTSDALE AZ
85260-8816
US

V. Phone/Fax

Practice location:
  • Phone: 818-924-9111
  • Fax:
Mailing address:
  • Phone: 406-239-3391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-08494T
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: