Healthcare Provider Details

I. General information

NPI: 1891984126
Provider Name (Legal Business Name): LLOYD ALAN WAGER LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 11/02/2025
Certification Date: 11/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 GREEN RIVER RD STE 113A
CORONA CA
92878-9185
US

IV. Provider business mailing address

11830 VERNON AVE
CHINO CA
91710-1963
US

V. Phone/Fax

Practice location:
  • Phone: 951-427-6001
  • Fax: 951-848-0686
Mailing address:
  • Phone: 909-497-0345
  • Fax: 951-848-0686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number50054
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: