MEDICARE: THERACARE LAS COLINAS

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1508725607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERACARE LAS COLINAS

Provider Business Mailing Address
First Line	:	7301 STATE HIGHWAY 161 STE 220
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-2827
Country	:	US
Telephone Number	:	682-253-2510
Fax Number	:

Provider Business Practice Location Address
First Line	:	7301 STATE HIGHWAY 161 STE 220
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-2827
Country	:	US
Telephone Number	:	682-253-2510
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TERRA WAGNER
Credential	:	PHD, LPC-S
Telephone Number	:	979-224-0310

Provider Enumeration Date	:	01/15/2026
Last Update Date	:	01/15/2026

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Directions to “THERACARE LAS COLINAS ” Practice Location

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