Jonathan Eric Wagner, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4525 Issued in MN

Practice address

2270 Ford Pkwy Ste 106
Saint Paul, MN 55116-3412

Phone

(612) 915-0049

NPI assigned

Feb 23, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Family Innovations IncGroup PAC ID 6204178528, 96 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Innovations, Inc.

  dba LifeStance Health

  • Counseling Psychologist
  • Anoka, MN
  • NPI 1992862783

  Professional

  Medicare reassignment Care Compare group NPD
• West Central Counseling LLC

  • Mental Health Counselor
  • Alexandria, MN
  • NPI 1649846650
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746057600000",
    "number": "1063006724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2270 FORD PKWY STE 106",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551163412",
            "telephone_number": "612-915-0049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2270 FORD PKWY STE 106",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551163412",
            "telephone_number": "612-915-0049"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "320 Annapolis St E",
            "address_purpose": "LOCATION",
            "city": "West St Paul",
            "state": "MN",
            "postal_code": "551181604",
            "country_code": "US",
            "telephone_number": "651-210-9549",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JONATHAN",
        "middle_name": "ERIC",
        "credential": "LPCC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-02-23",
        "last_updated": "2025-05-01",
        "certification_date": "2025-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "02291",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "4525",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF MINNESOTA",
            "identifier": "02291",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Procentive",
            "affiliation": "Y",
            "affiliationName": "Lakeview Behavioral Health LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "320 Annapolis St E",
            "city": "West St Paul",
            "state": "MN",
            "country_code": "US",
            "postal_code": "551181604",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Procentive",
            "affiliation": "Y",
            "affiliationName": "Lakeview Behavioral Health LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "320 Annapolis St E",
            "city": "West St Paul",
            "state": "MN",
            "country_code": "US",
            "postal_code": "551181604",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Corilyn Ashley Wagner
• Cynthia L Wagner, OTR/L
• Emily Ashley Wagner, MD
• Gerhardt Stefan Wagner, MD
• James Wagner, LMFT
• Keeli Nicole Wagner, LICSW
• Linnae Merith Wagner, PT
• Maria Joseph Wagner, RDCS
• Michael Hilmar Wagner, R.D., L.D.
• Nancy Wagner, PHD

• Professional Counselor in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.