Michelle Wagner, L.M.H.C., L.C.P.C.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

00768 Issued in IA

Practice address

11424 N Park RDG
Princeville, IL 61559-9136

Phone

(309) 210-5887

NPI assigned

Feb 9, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IA

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Compass Counseling Center, LLC

  dba The Compass, LLC

  • Mental Health Counselor
  • Princeville, IL
  • NPI 1861299356
  NPD Authorized official
• Genesis Health System

  dba Genesis Convenient Care Bettendorf

  • Clinic/Center
  • Bettendorf, IA
  • NPI 1497772008
  Medicare reassignment
• Genesis Health System

  dba Psychology Associates

  • Psychologist
  • Davenport, IA
  • NPI 1346220340

  Mental Health

  NPD
• Genesis Health System

  dba Genesis Health Group

  • Family Medicine Physician
  • Davenport, IA
  • NPI 1477654945
  NPD
• Genesis Health System

  dba Genesis Medical Center Dewitt

  • Critical Access Hospital
  • De Witt, IA
  • NPI 1649368523
  NPD

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781827200000",
    "number": "1467593962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11424 N PARK RDG",
            "city": "PRINCEVILLE",
            "state": "IL",
            "postal_code": "615599136",
            "telephone_number": "309-210-5887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11424 N PARK RDG",
            "city": "PRINCEVILLE",
            "state": "IL",
            "postal_code": "615599136",
            "telephone_number": "309-210-5887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MICHELLE",
        "credential": "L.M.H.C., L.C.P.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-09",
        "last_updated": "2026-06-19",
        "certification_date": "2026-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "00768",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0074526",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Proctor Health Systems (Carle Health Princeville)
• Monica Martha Pulley
• Victoria Schick
• Joshua Schupbach, MD
• Seeded Health PLLC

• Mental Health Counselor in Princeville, IL
• Providers in Princeville, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2026; 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.