Marisa Wagner, IMFT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

F.2400426 Issued in OH

Practice address

9104 State Route 108
Wauseon, OH 43567-9526

Phone

(419) 388-6663

NPI assigned

Aug 27, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Shalom Ministries

  dba Shalom Counseling & Mediation Center

  • Community/Behavioral Health Agency
  • Archbold, OH
  • NPI 1366573552
  NPD
• Deep Roots Wellness, LLC

  • Mental Health Counselor
  • Defiance, OH
  • NPI 1942799515
  NPD (past)

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

{
    "created_epoch": "1630022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748563200000",
    "number": "1336816271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9104 STATE ROUTE 108",
            "city": "WAUSEON",
            "state": "OH",
            "postal_code": "435679526",
            "telephone_number": "419-388-6663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9104 STATE ROUTE 108",
            "city": "WAUSEON",
            "state": "OH",
            "postal_code": "435679526",
            "telephone_number": "419-388-6663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MARISA",
        "credential": "IMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-27",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "M.2100239-TRNE",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "F.2400426",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO COUNSELOR, SOCIAL WORKER, AND MARRIAGE AND FAMILY THERAPY BOARD",
            "identifier": "M.2100239-TRNE",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anthony G Uribes, M.D.
• Shelby Vanbrandt
• Carol Vasko, LSW, LCDCIII
• Lekha Sai Vemuru
• Karen A. N. Vondeylen, LISW
• Steven Glenn Wagner
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2350)
• Wal-Mart Stores East, LP (Vision Center 30-2350)
• Jeanne Wallace
• Jacqueline Wallischeck

• Mental Health Counselor in Wauseon, OH
• Providers in Wauseon, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.