Miracle Wagner, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

72494 Issued in TX

Practice address

805 Washington Dr Ste D
Arlington, TX 76011-2528

Phone

(817) 264-6048

Fax

(817) 549-9755

NPI assigned

Jun 23, 2016

Last updated

Jun 11, 2019By 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 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Specialty

Mental Health Counselor

Education

Other, 2008

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: miraclewagner@tdh.allscriptsdirect.net

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.

• Miracle Works PLLC

  • Community/Behavioral Health Agency
  • Arlington, TX
  • NPI 1942759535
  NPD (past) Authorized official
• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Counselor

  NPD

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

{
    "created_epoch": "1466640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1548611387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 201593",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760061593",
            "telephone_number": "817-264-6048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 WASHINGTON DR STE D",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760112528",
            "telephone_number": "817-264-6048",
            "fax_number": "817-549-9755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MIRACLE",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-23",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "72494",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "360855601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie Wade, RN
• Jordan Waffird, DPT, PT
• James Wagers II
• Jaydee Ann Wagner
• Lauren A Wagner, LCSW
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-2977)
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-1801)
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-3870)
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-3284)
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-5416)

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.