Individual
MICHAEL JAMES WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
10207 E SHADY ROCK LN, TUCSON, AZ 85749-8162
(520) 631-2067
Mailing address
10207 E SHADY ROCK LN, TUCSON, AZ 85749-8162
(520) 631-2067
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
0119031
NM
103T00000X
Psychologist
Primary
4297
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78558
—
NM
Enumeration date
01/09/2009
Last updated
06/26/2012
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