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General NPI Number Information
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NPI Number | 1215483110
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Entity Type | Individual
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Provider Name | CHRISTINA WAGNER LMFT
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Gender | Female
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Dates
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Enumeration Date | 08/30/2016
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Last Update Date | 11/14/2016
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Provider Practice Location Address
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Address Line | 13706 RESEARCH BLVD SUITE 114
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City | AUSTIN
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State | TX
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Zip | 78750-1882
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Country | US
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Telephone | 512-426-3606
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Fax |
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Provider Business Mailing Address
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Address Line | 3620 FLORA VISTA LOOP
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City | ROUND ROCK
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State | TX
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Zip | 78681-1050
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Country | US
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Telephone | 512-426-3606
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 202137
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License Number State | TX
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