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General NPI Number Information
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NPI Number | 1568590255
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Entity Type | Individual
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Provider Name | HEATHER JEAN MARIE WAGNER B.S.
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Gender | Female
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 633 THOMPSON LN
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City | NASHVILLE
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State | TN
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Zip | 37204-3616
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Country | US
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Telephone | 615-463-6691
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Fax | 615-460-4434
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Provider Business Mailing Address
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Address Line | 1318 BRENTWOOD TER
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City | NASHVILLE
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State | TN
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Zip | 37211-7267
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Country | US
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Telephone | 615-714-3163
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Fax | 615-460-4434
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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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