Individual
BENJAMIN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
13707 FAIRHILL AVE, EDMOND, OK 73013-1946
(405) 412-3494
Mailing address
13707 FAIRHILL AVE, EDMOND, OK 73013-1946
(405) 412-3494
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPCCANDIDATE11099
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPCCANDIDATE11099
LICENSE BOARD
OK
Enumeration date
10/28/2022
Last updated
10/28/2022
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