| Doctor Name: | KYLE W WAGNER |
| NPI Number: | 1225308836 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | E0800066 |
| Business Practice Address: | 2884 Industrial Blvd Suite 13 Bethel Park, PA - 151022580 |
| Business Phone Number: | 4129450692 |
| Business Fax Number: | 4127742627 |
| Mailing Address: | 2884 Industrial Blvd, Suite 13 BETHEL PARK |
| State: | PA |
| Postal Code: | 151022580 |
| Phone Number: | 4129450692 |
| Fax Number: | 4127742627 |
| NPI Enumeration Date: | 01/12/2012 |
| NPI Last Update Date: | 04/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | E0800066 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |