Kellie Wagner, LAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LAC-21955 Issued in AZ

Practice address

10901 E McDowell Rd
Scottsdale, AZ 85256-5300

Phone

(480) 362-2603

NPI assigned

Aug 25, 2023

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

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, 2022

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Salt River Pima-Maricopa Indian Community

  • Community Health Clinic/Center
  • Scottsdale, AZ
  • NPI 1942668991

  TX

  Medicare reassignment

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

{
    "created_epoch": "1692921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692921600000",
    "number": "1760267165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10901 E MCDOWELL RD",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852565300",
            "telephone_number": "480-362-2603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10901 E MCDOWELL RD",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852565300",
            "telephone_number": "480-362-2603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KELLIE",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-25",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AZ",
            "license": "LAC-21955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cara Suzanne Wagen
• Joshua D. Waggoner, M.D.
• Sheldon Paul Wagman, D.O.
• Barrie Rachele Wagner, PSY. D.
• Brett Matthew Wagner, DC
• Madison Wagner, DC
• Sophie Wagner, RBT
• Madison Wagoner
• Mona Waheed, IBCLC
• Peyton Wahl

• Mental Health Counselor in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Mental Health Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2023; 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.