MEDICARE: DR. LILIET WAGNER PSY. D.

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	103TC0700X	Clinical Psychologist	PSY19080	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740369677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LILIET WAGNER PSY. D.

Provider Business Mailing Address
First Line	:	10740 N COUNTRY DR
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-7615
Country	:	US
Telephone Number	:	661-347-8286
Fax Number	:	818-474-7148

Provider Business Practice Location Address
First Line	:	22777 LYONS AVE STE 218
Second Line	:
City	:	NEWHALL
State	:	CA
Zip	:	91321-2853
Country	:	US
Telephone Number	:	661-347-8286
Fax Number	:	855-978-2704

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	02/11/2026

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