Organization
WAGNER ASSOCIATES PC
Active
Organization
WAGNER ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHRYN PARKS WAGNER PH.D. (SECRETARY)
(865) 212-5301
Entity
Organization
Contact information
Practice address
679 EMORY VALLEY ROAD, SUITE B, OAK RIDGE, TN 37830
(865) 212-5301
(865) 220-0782
Mailing address
679 EMORY VALLEY ROAD, SUITE B, OAK RIDGE, TN 37830
(865) 212-5301
(865) 220-0782
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
P0000000600
TN
103TC0700X
Clinical Psychologist
P0000001265
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3067696
BCBS
TN
05
—
3680317
—
TN
05
—
3682388
—
TN
01
—
78130
BCBS
TN
Enumeration date
12/01/2006
Last updated
08/22/2020
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