| Wagner And Associates Mental Health Services Llc | |
|
24500 Center Ridge Rd Ste 110 Westlake OH 44145-5604 | |
| (440) 296-2050 | |
| Not Available |
| Full Name | Wagner And Associates Mental Health Services Llc |
|---|---|
| Speciality | Counselor |
| Location | 24500 Center Ridge Rd Ste 110, 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 |
|---|---|
| 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 24500 Center Ridge Rd Ste 110 Westlake OH 44145-5604 Ph: (440) 296-2050 |
| NPI Number | 1215525712 |
|---|---|
| Provider Enumeration Date | 01/10/2021 |
| Last Update Date | 12/08/2023 |
| Certification Date | 12/08/2023 |
| Medicare PECOS PAC ID | 4082060710 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932694981 PECOS PAC ID: 1355795600 Enrollment ID: I20230920004159 |
| Provider Name | Phyliss Wagner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003325416 PECOS PAC ID: 1153777883 Enrollment ID: I20240307004043 |
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