Individual
JOHN M. WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S.
Contact information
Practice address
580 MOHAWK DR, BOULDER, CO 80303-3712
(303) 338-4545
Mailing address
10350 E DAKOTA AVE, DENVER, CO 80247-1314
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
NLC.0103614
CO
106H00000X
Marriage & Family Therapist
Primary
MFT.0001333
CO
Other
Enumeration date
05/05/2014
Last updated
06/11/2021
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