Doctor Name: | LANDI GAYLE WAGNER |
NPI Number: | 1316112006 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | BS |
License Number: | |
Business Practice Address: | 100 Kendall Dr Lamar, CO - 81052 |
Business Phone Number: | 7193367501 |
Business Fax Number: | 7193367453 |
Mailing Address: | 711 Barnes Ave, LA JUNTA |
State: | CO |
Postal Code: | 81050 |
Phone Number: | 7193845446 |
Fax Number: | 7193845672 |
NPI Enumeration Date: | 04/24/2008 |
NPI Last Update Date: | 10/08/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |