Brian Waggoner, LAC, NCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

A2401024 Issued in AR

Practice address

5310 W Village Pkwy Ste 4
Rogers, AR 72758-8201

Phone

(479) 435-8388

NPI assigned

Jan 24, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1706054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706227200000",
    "number": "1376305409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19369 NEILLS BLUFF RD",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727648503",
            "telephone_number": "630-740-7705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5310 W VILLAGE PKWY STE 4",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727588201",
            "telephone_number": "479-435-8388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "BRIAN",
        "name_prefix": "Mr.",
        "credential": "LAC, NCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-01-24",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": "A2401024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• W P Malone Inc
• Carly Waddell, MD
• Harrison Jake Waddell, DMD
• Jennifer Wade, O.T.
• Melissa Brooke Waganer, MOT, OTR/L
• Michael Waggoner, DO
• Nathan S Wagner, D.C.
• Allison Danielle Wahbi, LSW
• Wal-Mart Stores, Inc.
• Aimee Kathryne Waldrep, M.S, CCC-SLP

• Mental Health Counselor in Rogers, AR
• Providers in Rogers, AR by specialty
• Mental Health Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.