Wagoner, Keith Harold

Wagoner, Keith Harold is an individual health care provider with primary practice located at 2150 Stockton Blvd , Sacramento CA 95817-1337. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Other Service Providers / Case Manager/Care Coordinator, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Other Service Providers / Case Manager/Care Coordinator is his primary health care specialty. Wagoner, Keith Harold can be contacted via phone (916) 875-1000.

Contact Information

Primary practice address
2150 Stockton Blvd Sacramento CA 95817-1337
Phone: (916) 875-1000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X A022760416 California
Other Service Providers / Case Manager/Care Coordinator 171M00000X
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X

Profile Details

NPI number 1114268588
LBN Legal business name Wagoner, Keith Harold
Credentials COUNSELOR
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 11th, 2013
Last updated Aug 27th, 2024 - about 2 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 1114268588 NPPES
California MEDICAID 101Y00000X

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