Individual
JONATHAN STUART WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
1650 38TH ST STE 100E, BOULDER, CO 80301-2624
(720) 600-4830
Mailing address
3434 47TH ST STE 130, BOULDER, CO 80301-1802
(720) 600-4830
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LPCC.0023950
CO
101YP2500X
Professional Counselor
Primary
LPCC.0023950
CO
Other
Enumeration date
09/24/2025
Last updated
09/24/2025
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