Individual
JAMES L WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMHP
Contact information
Practice address
402 W 19TH ST, SOUTH SIOUX CITY, NE 68776-2639
(402) 494-5265
Mailing address
PO BOX 268, DAKOTA CITY, NE 68731-0268
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2311
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2311
—
NE
Enumeration date
04/22/2008
Last updated
01/12/2010
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