Individual
MR. BRADLEY JAY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
1321 WYOMING ST, MISSOULA, MT 59801-1725
(406) 532-9901
(406) 532-9901
Mailing address
140 N RUSSELL ST, MISSOULA, MT 59801-1704
(406) 532-9900
(406) 532-9901
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
29887
MT
Other
Enumeration date
03/29/2018
Last updated
03/29/2018
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