Pamela Jean Wagner, LPC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

LPC-21646 Issued in AZ

Practice address

3390 Marigold Dr
Prescott, AZ 86305-3714

Phone

(928) 499-2358

NPI assigned

Dec 21, 2022

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

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.

• Sea Glass Mental Health Inc

  • Professional Counselor
  • Scottsdale, AZ
  • NPI 1417688821
  NPD

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

{
    "created_epoch": "1671580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671580800000",
    "number": "1982316972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3390 MARIGOLD DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863053714",
            "telephone_number": "928-499-2358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3390 MARIGOLD DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863053714",
            "telephone_number": "928-499-2358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "PAMELA",
        "middle_name": "JEAN",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-12-21",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "AZ",
            "license": "LPC-21646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheri L Wages Cornell, PA-C
• Wagner & Associates PLLC
• Carole Eaton Wagner, FNP
• Gail Ann Wagner, M.S.
• Joy Wagner, RN
• Wal-Mart Stores, Inc. (Vision Center 30-5303)
• Jyoti Rajeev Walavalkar, MD
• Walgreen Co (Walgreens #09292)
• Walgreen Co (Walgreens #02555)
• Alan Paul Walicke, CCC-SLP

• Counselor in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2022; 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.