Active NPI
Kelli Wagner, LPC
- Mental Health Counselor
- Goodyear, AZ
National Provider Identifier
1306604343
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LPC-20244
- Practice address
- 15655 W Roosevelt St Ste 224
Goodyear, AZ 85338-9306 - Phone
- (928) 683-1720
- NPI assigned
- Mar 12, 2024
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LPC-20244 | AZ | Primary |
Addresses
Primary practice location
15655 W Roosevelt St Ste 224
Goodyear, AZ 85338-9306
Mailing address
15655 W Roosevelt St Ste 224
Goodyear, AZ 85338-9306
Phone (928) 683-1720
Other names 1
- Kelli Carpenter
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 15, 2024 through Jan 15, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC-20244 | AZ | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1710201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710201600000",
"number": "1306604343",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15655 W ROOSEVELT ST STE 224",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853389306",
"telephone_number": "928-683-1720"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15655 W ROOSEVELT ST STE 224",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853389306",
"telephone_number": "928-683-1720"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "KELLI",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-03-12",
"last_updated": "2024-03-12",
"certification_date": "2024-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "AZ",
"license": "LPC-20244",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KELLI",
"last_name": "CARPENTER",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Goodyear, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.