Individual
KEVIN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1977 BUTLER BLVD STE E4.400, HOUSTON, TX 77030-4101
(713) 798-4857
Mailing address
1977 BUTLER BLVD, HOUSTON, TX 77030-4101
(713) 798-3080
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
40475
TX
103TC0700X
Clinical Psychologist
40475
TX
Other
Enumeration date
04/08/2025
Last updated
07/28/2025
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