Miracle Works PLLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

72494 Issued in TX

Legal business name

MIRACLE WORKS PLLC

Practice address

805 Washington Dr Ste D
Arlington, TX 76011-2528

Phone

(817) 264-6048

Fax

(817) 549-9755

NPI assigned

Sep 24, 2016

Organization subpart

No

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

Authorized official

Name

Miracle Wagner, LPCNPI 1548611387

Title

Ceo/Director

Phone

(817) 264-6048

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

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

• Miracle Wagner, LPC

  • Professional Counselor
  • Arlington, TX
  • NPI 1548611387
  NPD (past) Authorized official

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

{
    "created_epoch": "1474675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1942759535",
    "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": {
        "organization_name": "MIRACLE WORKS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-24",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "MIRACLE",
        "authorized_official_title_or_position": "CEO/DIRECTOR",
        "authorized_official_telephone_number": "817-264-6048",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "TX",
            "license": "72494",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36085501",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "365158001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Arlington, TX
• Providers in Arlington, TX by specialty
• Community/Behavioral Health Agency 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.