Larry D Wagoner, PH.D., LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MT1162 Issued in FL

Practice address

7545 Centurion Pkwy
Suite # 105
Jacksonville, FL 32256-0579

Phone

(904) 642-2468

Fax

(904) 642-2469

NPI assigned

Oct 12, 2006

Last updated

Jan 29, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359417600000",
    "number": "1417046699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2058 BEACH AVE",
            "city": "ATLANTIC BEACH",
            "state": "FL",
            "postal_code": "322335935",
            "telephone_number": "904-372-7365",
            "fax_number": "904-372-7365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7545 CENTURION PKWY",
            "address_2": "SUITE # 105",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322560579",
            "telephone_number": "904-642-2468",
            "fax_number": "904-642-2469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "LARRY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "PH.D., LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2013-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "FL",
            "license": "MT1162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyle Wagner, DPT
• Laura J Wagner, LCSW
• Marie Pierrette Wagner
• Robert Fredrick Wagner Jr., D.D.S.
• Shakita Maria Wagner
• Aisha Waheed, M.D.
• Matthew Wahila, SLP
• Agnes Wozniak Wahl, NURSE PRACTITIONER
• Kelsey Wahl, DMD
• Evan Farrell Wahlquist

• Marriage & Family Therapist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Marriage & Family Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2013; 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.