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General NPI Number Information
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NPI Number | 1437255098
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Entity Type | Individual
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Provider Name | JOAN LYNN WAGNER M.A.
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Gender | Female
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 217 W CERRITOS AVE BLDG 8
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City | ANAHEIM
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State | CA
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Zip | 92805-6549
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Country | US
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Telephone | 714-254-8473
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Fax | 714-254-8480
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Provider Business Mailing Address
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Address Line | 817 N WOODS AVE
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City | FULLERTON
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State | CA
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Zip | 92832-1029
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Country | US
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Telephone | 714-526-2005
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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