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General NPI Number Information
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NPI Number | 1548567175
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Entity Type | Organization
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Legal Business Name | WAGNER BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 02/17/2011
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Last Update Date | 07/26/2019
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Provider Practice Location Address
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Address Line | 1001 STATE ST STE 102
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City | ERIE
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State | PA
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Zip | 16501-1835
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Country | US
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Telephone | 814-580-1743
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Fax | 814-240-6347
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Provider Business Mailing Address
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Address Line | 1001 STATE ST STE 102
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City | ERIE
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State | PA
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Zip | 16501-1835
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Country | US
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Telephone | 814-580-1743
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Fax | 814-240-6347
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Authorized Official
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Title or Position | MEDICAL BILLING SPECIALIST
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Name | PAUL KEARNEY
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Credential |
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Telephone | 814-580-1743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CW015648
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License Number State | PA
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