Active NPI
Jonathan Stewart Wagner, LPC-MHSP, NCC
- Mental Health Counselor
- Nampa, ID
National Provider Identifier
1679144836
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 4117
- Practice address
- 2141 W Moose Creek Dr
Nampa, ID 83686-5185 - Phone
- (615) 426-7352
- NPI assigned
- Jul 8, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 4117 | TN | Primary |
Addresses
Primary practice location
2141 W Moose Creek Dr
Nampa, ID 83686-5185
Mailing address
2141 W Moose Creek Dr
Nampa, ID 83686-5185
Phone (615) 426-7352
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NA | Other | TN | NA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4117 | TN | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625702400000",
"number": "1679144836",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2141 W MOOSE CREEK DR",
"city": "NAMPA",
"state": "ID",
"postal_code": "836865185",
"telephone_number": "615-426-7352"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2141 W MOOSE CREEK DR",
"city": "NAMPA",
"state": "ID",
"postal_code": "836865185",
"telephone_number": "615-426-7352"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "JONATHAN",
"middle_name": "STEWART",
"name_prefix": "Mr.",
"credential": "LPC-MHSP, NCC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-07-08",
"last_updated": "2021-07-08",
"certification_date": "2021-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TN",
"license": "4117",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NA",
"identifier": "NA",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Nampa, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.