Basic Information
| Provider Information | |||||||||
| NPI: | 1982024691 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOE WAGNER, LPC, L.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6744 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701746744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043097844 | ||||||||
| FaxNumber: | 5043097845 | ||||||||
| Practice Location | |||||||||
| Address1: | 4300 S I 10 SERVICE RD W | ||||||||
| Address2: | STE. 103S | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700017405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5042651570 | ||||||||
| FaxNumber: | 5043097845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2014 | ||||||||
| LastUpdateDate: | 04/21/2014 | ||||||||
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| AuthorizedOfficialLastName: | SANCHEZ | ||||||||
| AuthorizedOfficialFirstName: | LAURIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5043097844 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC 4420 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.