Healthcare Provider Details

I. General information

NPI: 1871421305
Provider Name (Legal Business Name): ARTHUR J WAGNER AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 OLYMPIC BLVD STE 365
WALNUT CREEK CA
94596-5096
US

IV. Provider business mailing address

1024 COUNTRY CLUB DR # 135
MORAGA CA
94556-1900
US

V. Phone/Fax

Practice location:
  • Phone: 877-676-7634
  • Fax:
Mailing address:
  • Phone: 925-268-8272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT148437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: