Organization
YOUTH OF LEWIS COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WYATT M WAGNER (EXECUTIVE DIRECTOR)
(315) 816-6448
Entity
Organization
Contact information
Practice address
9502 STATE ROUTE 12 APT 2, COPENHAGEN, NY 13626-2952
(315) 816-6448
Mailing address
9502 STATE ROUTE 12 APT 2, COPENHAGEN, NY 13626-2952
(315) 816-6448
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
10/08/2024
Last updated
10/08/2024
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