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Lisa Fae Wagner
Mental Health Counselor in Agoura Hills, California
NPI 1659963502

Lisa Fae Wagner is a Mental Health Counselor based in Agoura Hills, CA and is specialized in Mental Health. Lisa Fae Wagner practices in Agoura Hills, CA. The NPI Number for Lisa Fae Wagner is 1659963502 and holds a License No. 40867 (California).

The current practice location address for Lisa Fae Wagner is 29532 Bertrand Dr, Agoura Hills, CA and can be reached out via phone at 310-480-1719.

Location: 29532 Bertrand Dr, Agoura Hills, CA, 91301-4100
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1659963502
Provider Name
Lisa Fae Wagner
Credential
Provider Entity Type
Individual
Gender
Female
Address
29532 Bertrand Dr, Agoura Hills, CA, 91301-4100
Phone Number
310-480-1719
Fax Number
Provider Enumeration Date
02/10/2021
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
29532 Bertrand Dr
City
Agoura Hills
State
California
Zip
91301-4100
Phone Number
310-480-1719
Fax Number
person
Provider Business Mailing Address Details
Address
29532 Bertrand Dr
City
Agoura Hills
State
California
Zip
91301-4100
Phone Number
310-480-1719
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
40867 (California)
Definition
Definition to come...
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