MEDICARE: WAGSTAFF COUNSELING SERVICES LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1366307951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAGSTAFF COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	610 LINDSAY ST
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37403-3405
Country	:	US
Telephone Number	:	205-913-3780
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 LINDSAY ST
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37403-3405
Country	:	US
Telephone Number	:	205-913-3780
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE/ SOLE PROPRIETOR
Name	:	LAURA WAGSTAFF
Credential	:	LPC-MHSP
Telephone Number	:	205-582-7810

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/17/2025

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