Organization
TIDEMARK THERAPY PLLC
Active
Organization
TIDEMARK THERAPY PLLC
Active
Other names
Brittainy A. Wagner, LPC
Organization subpart
No
Provider details
NPI number
Authorized official
BRITTAINY A WAGNER LPC (OWNER PROVIDER)
(903) 267-4023
Entity
Organization
Contact information
Practice address
305 W WOODARD ST STE 201, DENISON, TX 75020-3136
(903) 265-8545
(903) 487-0600
Mailing address
305 W WOODARD ST STE 201, DENISON, TX 75020-3276
(903) 265-8545
(903) 487-0600
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
11/05/2014
Last updated
02/24/2026
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