Individual
KEELY LOUISE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LLP, MS
Contact information
Practice address
7640 DIXIE HWY STE 155, CLARKSTON, MI 48346-2095
(248) 791-9266
Mailing address
2790 INTERNATIONAL DR APT 534C, YPSILANTI, MI 48197-8527
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
6362009086
MI
103T00000X
Psychologist
Primary
6361007929
MI
Other
Enumeration date
10/01/2020
Last updated
09/04/2024
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