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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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