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General NPI Number Information
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NPI Number | 1215525712
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Entity Type | Organization
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Legal Business Name | WAGNER AND ASSOCIATES MENTAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 01/10/2021
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 842 CORPORATE WAY STE 850
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City | WESTLAKE
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State | OH
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Zip | 44145-1537
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Country | US
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Telephone | 440-296-2050
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Fax |
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Provider Business Mailing Address
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Address Line | 107 WOODSTOCK DR
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City | AVON LAKE
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State | OH
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Zip | 44012-1622
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Country | US
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Telephone | 440-296-2050
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PHYLLISS WAGNER
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Credential | LPCC
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Telephone | 440-296-2050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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