Active NPI
Natasha Marie Wagner, LPC
- Professional Counselor
- Florence, AZ
National Provider Identifier
1336713080
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401008764
- Practice address
- 5909 W Autumn Vista Way
Florence, AZ 85132-1294 - Phone
- (480) 540-1099
- NPI assigned
- May 18, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 | 6401008764 | MI | Primary |
Addresses
Primary practice location
5909 W Autumn Vista Way
Florence, AZ 85132-1294
Mailing address
5909 W Autumn Vista Way
Florence, AZ 85132-1294
Phone (480) 540-1099
Other names 1
- Natasha Marie Johnson
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 |
|---|---|---|---|
| 6401008764 | MI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621296000000",
"number": "1336713080",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5909 W AUTUMN VISTA WAY",
"city": "FLORENCE",
"state": "AZ",
"postal_code": "851321294",
"telephone_number": "480-540-1099"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5909 W AUTUMN VISTA WAY",
"city": "FLORENCE",
"state": "AZ",
"postal_code": "851321294",
"telephone_number": "480-540-1099"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "NATASHA",
"middle_name": "MARIE",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-05-18",
"last_updated": "2021-05-18",
"certification_date": "2021-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401008764",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "NATASHA",
"last_name": "JOHNSON",
"middle_name": "MARIE",
"credential": "LPC",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Florence, AZ
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- Justin Wayne Vanscoder
- Louis Eduardo Velasco III, M.D.
- Robert C Wakefield, PA-C
- Deborah Walker, MS, OTR/L
- Mary L Walker, FNP
- Candace Waltz
- Wesley Watson, PT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.