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Organization
WAGENER THERAPY PLC
Active
Organization
WAGENER THERAPY PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDAL J WAGENER LMHC (OWNER)
(224) 216-4209
Entity
Organization
Contact information
Practice address
6119 DEERE CREEK LN, DAVENPORT, IA 52807-3402
(224) 216-4209
Mailing address
4620 E 53RD ST, DAVENPORT, IA 52807-3620
(224) 216-4209
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
NULL
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
11/23/2021
Last updated
05/08/2023
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