Wagoner'S Psychological Services, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

WAGONER'S PSYCHOLOGICAL SERVICES, LLC

Practice address

2675 Medway New Carlisle Rd
Medway, OH 45341-9744

Phone

(937) 856-7066

NPI assigned

Sep 15, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Alicia Wagoner, PSY.D.NPI 1265922504

Title

Owner

Phone

(937) 546-1083

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alicia Wagoner, PSY.D

  • Clinical Psychologist
  • Medway, OH
  • NPI 1265922504
  NPD Authorized official

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

{
    "created_epoch": "1694736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694736000000",
    "number": "1669250296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 MEDWAY NEW CARLISLE RD",
            "city": "MEDWAY",
            "state": "OH",
            "postal_code": "453419744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2675 MEDWAY NEW CARLISLE RD",
            "city": "MEDWAY",
            "state": "OH",
            "postal_code": "453419744",
            "telephone_number": "937-856-7066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGONER'S PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-15",
        "last_updated": "2023-09-15",
        "certification_date": "2023-09-15",
        "status": "A",
        "authorized_official_last_name": "WAGONER",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "937-546-1083",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chandler Phillips, M.D.
• Bethany A Rose, LPN
• Claudia Lee Shellabarger
• Michelle Renee Stafford, ATC
• Alicia Wagoner, PSY.D
• Irene White
• Brooke A Willmeth

• Mental Health Clinic/Center (Including Community Mental Health Center) in Medway, OH
• Providers in Medway, OH by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2023; 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.