Individual
KELLIE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
10901 E MCDOWELL RD, SCOTTSDALE, AZ 85256-5300
(480) 362-2603
Mailing address
10901 E MCDOWELL RD, SCOTTSDALE, AZ 85256-5300
(480) 362-2603
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LAC-21955
AZ
Other
Enumeration date
08/25/2023
Last updated
08/25/2023
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