MEDICARE: AVERY WAGEMAN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	90746	TX
2	101YP2500X	Professional Counselor	0022329	CO
3	101YM0800X	Mental Health Counselor	90746	TX

General Provider Information

NPI Number	:	1043034614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVERY WAGEMAN LPC

Provider Business Mailing Address
First Line	:	1420 W MCDERMOTT DR APT 515
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-3302
Country	:	US
Telephone Number	:	903-421-3833
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 W MCDERMOTT DR APT 515
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-3302
Country	:	US
Telephone Number	:	903-421-3833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2024
Last Update Date	:	03/09/2026

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Directions to “ AVERY WAGEMAN LPC” Practice Location

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