NPIMap

Organization Active NPI

Wagner and Associates Mental Health Services LLC

  • Professional Counselor
  • Westlake, OH
National Provider Identifier
1215525712
Registry record updated Sep 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
WAGNER AND ASSOCIATES MENTAL HEALTH SERVICES LLC
Practice address
842 Corporate Way Ste 850
Westlake, OH 44145-1537
Phone
(440) 296-2050
NPI assigned
Jan 10, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2024

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

Authorized official

Name
Phylliss Wagner, LPCC
Title
Owner
Phone
(440) 296-2050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X Primary

Addresses

Primary practice location

842 Corporate Way Ste 850
Westlake, OH 44145-1537

Mailing address

107 Woodstock Dr
Avon Lake, OH 44012-1622
Phone (440) 296-2050

Other practice location 1

107 Woodstock Dr
Avon Lake, OH 44012-1622
Phone (440) 296-2050

Other practice location 2

24500 Center Ridge Rd Ste 110
Westlake, OH 44145-5604
Phone (440) 296-2050

Other identifiers 1

IdentifierTypeStateIssuer
E.2001993OtherOHOH LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231031003613 OH Part B Supplier - Clinic/Group Practice 4082060710 Receives reassigned benefits from 6 practitioners
Practice locations: Westlake, OH

National Provider Directory

National Provider Directory

Locations

842 Corporate Way
Ste 850
Westlake, OH 44145
Phone (440) 296-2050

24500 Center Ridge Rd
Ste 110
Westlake, OH 44145
Phone (440) 522-9810

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1610236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727222400000",
    "number": "1215525712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 WOODSTOCK DR",
            "city": "AVON LAKE",
            "state": "OH",
            "postal_code": "440121622",
            "telephone_number": "440-296-2050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "842 CORPORATE WAY STE 850",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441451537",
            "telephone_number": "440-296-2050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "107 Woodstock Dr",
            "address_purpose": "LOCATION",
            "city": "Avon Lake",
            "state": "OH",
            "postal_code": "440121622",
            "country_code": "US",
            "telephone_number": "440-296-2050",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "24500 Center Ridge Rd Ste 110",
            "address_purpose": "LOCATION",
            "city": "Westlake",
            "state": "OH",
            "postal_code": "441455604",
            "country_code": "US",
            "telephone_number": "440-296-2050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WAGNER AND ASSOCIATES MENTAL HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-10",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "PHYLLISS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "440-296-2050",
        "authorized_official_credential": "LPCC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OH LICENSE",
            "identifier": "E.2001993",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Westlake, OH

Sources for this page

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

Verify at the official NPI Registry.