Healthcare Provider Details

I. General information

NPI: 1013811918
Provider Name (Legal Business Name): ANDREW WAGERS LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 N WIGET LN STE 150
WALNUT CREEK CA
94598-2468
US

IV. Provider business mailing address

15D OLIVA DR
NOVATO CA
94947-2122
US

V. Phone/Fax

Practice location:
  • Phone: 925-798-7250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMF40642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: