Jennifer Wagner, LPC, LCDC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

78248 Issued in TX

Practice address

702 Holly St
Atlanta, TX 75551-2308

Phone

(903) 278-7795

NPI assigned

May 2, 2017

Last updated

Aug 3, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Enrolled in TX

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

Specialty

Mental Health Counselor

Education

Other, 2016

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Mental Health Specialty Group PA

  dba Rula Health

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  Professional, TX

  Medicare reassignment NPD
• Sabine Valley Regional MHMR Center

  dba Community Healthcore

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Longview, TX
  • NPI 1639232002

  Professional

  NPD
• Sabine Valley Regional MHMR Center

  dba Community Healthcore

  • Family Medicine Physician
  • Longview, TX
  • NPI 1841835022
  NPD

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

{
    "created_epoch": "1493683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596412800000",
    "number": "1508392135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 777",
            "city": "ATLANTA",
            "state": "TX",
            "postal_code": "755510777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 HOLLY ST",
            "city": "ATLANTA",
            "state": "TX",
            "postal_code": "755512308",
            "telephone_number": "903-278-7795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JENNIFER",
        "credential": "LPC, LCDC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-02",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "13846",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "78248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelli Michelle Thompson, APRN, FNP-C
• Total Renal Care Inc (Northeast Texas Dialysis)
• Robert Terry Trawnik, B.C.O.
• Rosharon Shunta Turner, LPC
• Kayla Underwood, FNP
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 100226)
• Wal-Mart Stores Texas, LP (Vision Center 30-0226)
• Scott A Walls, M.D.
• Wesley Partners, LTD. (Wesley House)
• White Cat, Inc

• Professional Counselor in Atlanta, TX
• Providers in Atlanta, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.