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Mr. Jonathan Stewart Wagner, LPC-MHSP,NCC
Mental Health Counselor in Nampa, Idaho
NPI 1679144836

Jonathan Stewart Wagner is a Mental Health Counselor based in Nampa, ID and is specialized in Mental Health. Jonathan Stewart Wagner practices in Nampa, ID and has the professional credentials of LPC-MHSP,NCC. The NPI Number for Jonathan Stewart Wagner is 1679144836 and holds a License No. 4117 (Idaho).

The current practice location address for Jonathan Stewart Wagner is 2141 W Moose Creek Dr, Nampa, ID and can be reached out via phone at 615-426-7352.

Location: 2141 W Moose Creek Dr, Nampa, ID, 83686-5185
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1679144836
Provider Name
Jonathan Stewart Wagner
Credential
LPC-MHSP,NCC
Provider Entity Type
Individual
Gender
Male
Address
2141 W Moose Creek Dr, Nampa, ID, 83686-5185
Phone Number
615-426-7352
Fax Number
Provider Enumeration Date
07/08/2021
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
NA 01 TN NA
institution
Provider Business Practice Location Address Details
Address
2141 W Moose Creek Dr
City
Nampa
State
Idaho
Zip
83686-5185
Phone Number
615-426-7352
Fax Number
person
Provider Business Mailing Address Details
Address
2141 W Moose Creek Dr
City
Nampa
State
Idaho
Zip
83686-5185
Phone Number
615-426-7352
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
4117 (Tennessee)
Definition
Definition to come...
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