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General NPI Number Information
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NPI Number | 1639358385
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Entity Type | Individual
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Provider Name | BEATRIX WAGNER PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 09/02/2015
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Provider Practice Location Address
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Address Line | 6300 JOHN RYAN DR
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City | FORT WORTH
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State | TX
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Zip | 76132-4122
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Country | US
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Telephone | 844-244-3738
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Fax |
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Provider Business Mailing Address
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Address Line | 5141 SKYLINE DR
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City | FRISCO
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State | TX
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Zip | 75034-8867
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Country | US
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Telephone | 844-284-3278
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY23746
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License Number State | CA
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