Individual
MS. LAURA LEE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., LMHC, LCAC
Contact information
Practice address
601 STADIUM MALL DR, WEST LAFAYETTE, IN 47907-2052
(765) 494-6995
(765) 496-2139
Mailing address
418 N ABIGAIL ST, RENSSELAER, IN 47978-2402
(219) 866-0006
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87000662A
IN
101YP2500X
Professional Counselor
Primary
39002286A
IN
Other
Enumeration date
01/23/2018
Last updated
01/23/2018
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