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Individual

MR. ALLEN WAGNER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.A.

Contact information

Practice address
5757 WILSHIRE BLVD STE 635, LOS ANGELES, CA 90036-3686
(310) 429-5310
(323) 931-6027
Mailing address
5757 WILSHIRE BLVD STE 635, LOS ANGELES, CA 90036-3686
(310) 429-5310
(323) 931-6027

Taxonomy

Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MFC45448
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0000730
CA
Enumeration date
03/07/2007
Last updated
09/22/2016
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