Rebecca Wagner, M.A.

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

126197 Issued in CA

Practice address

PO Box 602
Arcata, CA 95518-0602

Phone

(707) 366-0197

NPI assigned

Jan 17, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/eef7bdb7-cd7b-4ec1-b846-cf9ec1db80c8/

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.

• Changing Tides Family Services

  • Community/Behavioral Health Agency
  • Eureka, CA
  • NPI 1336453505
  NPD (past)

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

{
    "created_epoch": "1484611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732492800000",
    "number": "1194261032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955180602",
            "telephone_number": "707-366-0197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 602",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955180602",
            "telephone_number": "707-366-0197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "REBECCA",
        "credential": "M.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-17",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "IMF100236",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "126197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yesica J Vitela
• Philip John Vogelsang, M.D., PH.D.
• Shannen Vong, PHD
• Kelvin K Vu, D.O.
• Katrina Sista Marie Wagner
• Ginette G Walker
• Grant Edward Walker, MD
• Jessica Lynn Walkner, M.A., P.P.S, L.E.P.
• Mariah Walters-Asbury
• Elizabeth Jo Walters

• Marriage & Family Therapist in Arcata, CA
• Providers in Arcata, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.