Organization
MIRACLE WORKS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIRACLE WAGNER LPC (CEO/DIRECTOR)
(817) 264-6048
Entity
Organization
Contact information
Practice address
805 WASHINGTON DR STE D, ARLINGTON, TX 76011-2528
(817) 264-6048
(817) 549-9755
Mailing address
PO BOX 201593, ARLINGTON, TX 76006-1593
(817) 264-6048
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
72494
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36085501
—
TX
05
—
365158001
—
TX
Enumeration date
09/24/2016
Last updated
06/11/2019
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