Wagner And Associates Mental Health Services Llc | |
842 Corporate Way Ste 850 Westlake OH 44145-1537 | |
(440) 296-2050 | |
Not Available |
Full Name | Wagner And Associates Mental Health Services Llc |
---|---|
Speciality | Counselor |
Location | 842 Corporate Way Ste 850, Westlake, Ohio |
Authorized Official Name and Position | Phylliss Wagner (OWNER) |
Authorized Official Contact | 4402962050 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Wagner And Associates Mental Health Services Llc 107 Woodstock Dr Avon Lake OH 44012-1622 Ph: (440) 296-2050 | Wagner And Associates Mental Health Services Llc 842 Corporate Way Ste 850 Westlake OH 44145-1537 Ph: (440) 296-2050 |
NPI Number | 1215525712 |
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Provider Enumeration Date | 01/10/2021 |
Last Update Date | 09/25/2024 |
Certification Date | 09/25/2024 |
Medicare PECOS PAC ID | 4082060710 |
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Medicare Enrollment ID | O20231031003613 |
Identifier | Type | State | Issuer |
---|---|---|---|
1215525712 | NPI | - | NPPES |
E.2001993 | Other | OH | OH LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
Provider Name | Crystal Valentine |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1932694981 PECOS PAC ID: 1355795600 Enrollment ID: I20230920004159 |
Provider Name | Phyliss Wagner |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1003325416 PECOS PAC ID: 1153777883 Enrollment ID: I20240307004043 |
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