Active NPI
Jeffrey Wagner, LPCC
- Professional Counselor
- San Diego, CA
National Provider Identifier
1255731402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 11955
- Practice address
- 2865 Logan Ave
San Diego, CA 92113-2411 - Phone
- (619) 232-4357
- NPI assigned
- Aug 25, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 11955 | CA | Primary |
Addresses
Primary practice location
2865 Logan Ave
San Diego, CA 92113-2411
Mailing address
2865 Logan Ave
San Diego, CA 92113-2411
Phone (619) 232-4357
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 37378100 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11955 | CA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761782400000",
"number": "1255731402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2865 LOGAN AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921132411",
"telephone_number": "619-232-4357"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2865 LOGAN AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921132411",
"telephone_number": "619-232-4357"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "JEFFREY",
"credential": "LPCC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-08-25",
"last_updated": "2025-10-30",
"certification_date": "2025-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CA",
"license": "11955",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "37378100",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.