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Individual
JASON FREDRICK WAGNER
Active
Individual
JASON FREDRICK WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN, LMHC, MCAP
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
MH8961
FL
101YM0800X
Mental Health Counselor
MH8961
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN11004343
FL
Other
Enumeration date
09/20/2016
Last updated
05/01/2024
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