Individual
KELL WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NCC, LPC ASSOCIATE
Contact information
Practice address
1040 CRATER LAKE AVE STE D, MEDFORD, OR 97504-6295
(541) 840-7684
Mailing address
1040 CRATER LAKE AVE STE D, MEDFORD, OR 97504-6295
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C6938
OR
Other
Enumeration date
10/06/2015
Last updated
01/18/2024
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