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NPI Code Detail

MEDICARE: JASON ROBERT WAGNER CMHC

MEDICARE: JASON ROBERT WAGNER CMHC
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
1101YM0800XMental Health Counselor7717626-6009UT

General Provider Information

NPI Number : 1053700765
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON ROBERT WAGNER CMHC
Provider Business Mailing Address
First Line : 9844 S 1300 E STE 250
Second Line :
City : SANDY
State : UT
Zip : 84094-4691
Country : US
Telephone Number : 801-243-2928
Fax Number :
Provider Business Practice Location Address
First Line : 9844 S 1300 E STE 250
Second Line :
City : SANDY
State : UT
Zip : 84094-4691
Country : US
Telephone Number : 801-243-2928
Fax Number : 801-609-3649
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2015
Last Update Date : 07/24/2024

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Directions to “ JASON ROBERT WAGNER CMHC” Practice Location

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