Organization
LISA WAGNER
Active
Other names
Wagner Consultant Services
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA D WAGNER LMSW (SOCIAL WORKER)
(832) 563-3237
Entity
Organization
Contact information
Practice address
5420 DASHWOOD DR, SUITE 210, HOUSTON, TX 77081-5357
(713) 839-9898
(713) 839-9494
Mailing address
7619 PORTAL DR, HOUSTON, TX 77071-1828
(832) 563-3237
(713) 995-9348
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
09909
TX
261QF0050X
Non-Surgical Family Planning Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09909
SOCIAL WORK LICENSE NUMBER
TX
05
—
180057501
—
TX
05
—
180057502
—
TX
Enumeration date
08/17/2006
Last updated
06/23/2008
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