Individual
MRS. GAIL ANN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
143 E MERRITT ST, PRESCOTT, AZ 86301-2028
(928) 445-5027
(928) 445-7071
Mailing address
143 E MERRITT ST, PRESCOTT, AZ 86301-2028
(928) 445-5027
(928) 445-7071
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC0404
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11586734
CAQH
AZ
Enumeration date
07/24/2006
Last updated
07/08/2007
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