MEDICARE: REDEEMED MENTAL HEALTH

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2080P0008X	Pediatric Neurodevelopmental Disabilities Physician
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1952084451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDEEMED MENTAL HEALTH

Provider Business Mailing Address
First Line	:	456 OLD NEWPORT BLVD
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4211
Country	:	US
Telephone Number	:	949-782-2254
Fax Number	:	949-203-6158

Provider Business Practice Location Address
First Line	:	456 OLD NEWPORT BLVD
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4211
Country	:	US
Telephone Number	:	949-782-2254
Fax Number	:	949-203-6158

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	DR. ANDREA MARIE WAGNER
Credential	:	PSY.D.
Telephone Number	:	949-782-2254

Provider Enumeration Date	:	08/10/2023
Last Update Date	:	05/09/2026

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Directions to “REDEEMED MENTAL HEALTH ” Practice Location

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