Wagner, Miracle

Wagner, Miracle is an sole proprietor health care provider with primary practice located at 805 Washington Dr Ste D , Arlington TX 76011-2528. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Wagner, Miracle can be contacted via phone (817) 264-6048.

Contact Information

Primary practice address
805 Washington Dr Ste D Arlington TX 76011-2528
Phone: (817) 264-6048
Fax: (817) 549-9755
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X
Behavioral Health & Social Service Providers / Mental Health 101YM0800X
Behavioral Health & Social Service Providers / Professional 101YP2500X 72494 Texas

Profile Details

NPI number 1548611387
LBN Legal business name Wagner, Miracle
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 23rd, 2016
Last updated Jun 11th, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1548611387 NPPES
Texas MEDICAID 360855601

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