Jacob Arnold Wagner, LSP, ED.S

Primary specialty

School PsychologistTaxonomy code 103TS0200X

License

000748846 Issued in TN

Practice address

2292 Chambliss Ave NW Ste C2
Cleveland, TN 37311-3862

Phone

(423) 479-5672

Fax

(423) 479-5679

NPI assigned

Jun 25, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Tom a. Biller Ed.D. P.C. Dba Health Management Services

  • Clinical Psychologist
  • Cleveland, TN
  • NPI 1912047671
  NPD

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

{
    "created_epoch": "1719273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1497590277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2292 CHAMBLISS AVE NW STE C2",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373113862",
            "telephone_number": "423-479-5672",
            "fax_number": "423-479-5679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2292 CHAMBLISS AVE NW STE C2",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373113862",
            "telephone_number": "423-479-5672",
            "fax_number": "423-479-5679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JACOB",
        "middle_name": "ARNOLD",
        "name_prefix": "Mr.",
        "credential": "LSP, ED.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-25",
        "last_updated": "2024-06-25",
        "certification_date": "2024-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "TN",
            "license": "000748846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• School Psychologist in Cleveland, TN
• Providers in Cleveland, TN by specialty
• School Psychologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.