Larry D Wagoner in Jacksonville - Marriage & Family Therapist
Larry D Wagoner - NPI 1417046699
Larry D Wagoner is a Marriage & Family Therapist in Jacksonville, Florida. Larry D Wagoner practices all healthcare services and medical treatments related to Marriage & Family Therapist. The NPI Number for Larry D Wagoner is 1417046699. The last update date is 2013-01-29.
Larry D Wagoner's current location address is 7545 Centurion Pkwy, Jacksonville, Florida. You can contact this provider via phone number 9046422468 and fax number 9046422469. The mailing address for Larry D Wagoner is 7545 Centurion Pkwy, Jacksonville, Florida. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Larry D Wagoner |
|---|---|
| Address | 7545 Centurion Pkwy, Jacksonville, Florida |
| Phone Number | 9046422468 |
| Fax Number | 9046422469 |
| Sole Proprietor | Y |
| Credentials | PH.D., LMF |
NPI Number Detail
| NPI Number | 1417046699 |
|---|---|
| Provider Enumeration Date | 2006-10-12 |
| Last Updated Date | 2013-01-29 |
Provider Mailing Address Detail
| Address | 7545 Centurion Pkwy |
|---|---|
| City | Jacksonville |
| State | Florida (FL) |
| Post Code | 322560579 |
| Phone Number | 9046422468 |
| Fax Number | 9046422469 |
Provider's Primary Taxonomy Detail
| Speciality | Marriage & Family Therapist |
|---|---|
| Taxonomy | 106H00000X |
| Licence No | MT1162 |
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Definition: A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives |
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What is the unique identification code assigned to Larry D Wagoner by the Centers for Medicare & Medicaid Services?
The Larry D Wagoner has been issued the NPI (National Provider Identifier) 1417046699. This 10-digit code serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you share the physical location details of Larry D Wagoner?
The Larry D Wagoner is situated at 7545 Centurion Pkwy, in the city of Jacksonville, state of FL, with the zip code 322560579.
What is the Larry D Wagoner's specialty and taxonomy code?
The Larry D Wagoner's specialty is Marriage & Family Therapist, and the corresponding taxonomy code is 106H00000X.
On what date did the Centers for Medicare & Medicaid Services issue the 1417046699 to Larry D Wagoner?
The Larry D Wagoner received its 1417046699 assignment from the Centers for Medicare & Medicaid Services on 2006-10-12.
When was the information related to Larry D Wagoner most recently updated or refreshed?
The details pertaining to the Larry D Wagoner, including its address, specialty, and other relevant information, were last updated or refreshed on 2013-01-29.