Madison Gabrielle Wagner, LMHC, NCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

093041 Issued in IA

Practice address

1820 Central Ave
Estherville, IA 51334-2409

Phone

(800) 592-0180

NPI assigned

Sep 4, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 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

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.

• Moxie Nova

  • Mental Health Counselor
  • Estherville, IA
  • NPI 1609551787

  IA, Mental Health

  Medicare reassignment NPD
• Champion State of Mind PLLC

  • Mental Health Counselor
  • Estherville, IA
  • NPI 1033578331

  Mental Health

  NPD (past)

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

{
    "created_epoch": "1599177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613606400000",
    "number": "1598379752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 36",
            "city": "ESTHERVILLE",
            "state": "IA",
            "postal_code": "513340036",
            "telephone_number": "800-592-0180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1820 CENTRAL AVE",
            "city": "ESTHERVILLE",
            "state": "IA",
            "postal_code": "513342409",
            "telephone_number": "800-592-0180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "MADISON",
        "middle_name": "GABRIELLE",
        "credential": "LMHC, NCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-04",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "093041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mgarst@championmind.org",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1820 Central Ave",
            "city": "Estherville",
            "state": "IA",
            "country_code": "US",
            "postal_code": "513342409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Andrew Lon Spurgin, PHARMD
• Douglas V. Stangl, M.D.
• Lorraine Marie Tangen, MD
• The Evangelical Lutheran Good Samaritan Society
• Kimberly Sue Venteicher, ATC
• Sarah Elizabeth Walker-Loring, ARNP
• Dawn M Webb, O.D.
• Jean M Wheeler, LMSW
• Steven Russell Whiting, R.PH.
• Gregory James Williams, DDS

• All providers in Estherville, IA
• Mental Health Counselor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; 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.