1952398075 NPI number — LINDA WAGNER LPC

Table of content: LINDA WAGNER LPC (NPI 1952398075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952398075 NPI number — LINDA WAGNER LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAGNER
Provider First Name:
LINDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952398075
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5862 CROMO DR
Provider Second Line Business Mailing Address:
SUITE 145
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79912-5551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-585-9760
Provider Business Mailing Address Fax Number:
915-842-0054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5862 CROMO DR
Provider Second Line Business Practice Location Address:
SUITE 145
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79912-5551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-585-9760
Provider Business Practice Location Address Fax Number:
915-842-0054
Provider Enumeration Date:
10/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  12443 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 82773L . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com