Individual
KELLI WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
15655 W ROOSEVELT ST STE 224, GOODYEAR, AZ 85338-9306
(928) 683-1720
Mailing address
15655 W ROOSEVELT ST STE 224, GOODYEAR, AZ 85338-9306
(928) 683-1720
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-20244
AZ
Other
Enumeration date
03/12/2024
Last updated
03/12/2024
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