Provider Demographics
NPI:1073366084
Name:WAGONER, HUNTER (PLPC)
Entity Type:Individual
Prefix:
First Name:HUNTER
Middle Name:
Last Name:WAGONER
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6055 MEXICO RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1632
Mailing Address - Country:US
Mailing Address - Phone:636-294-2694
Mailing Address - Fax:636-222-9277
Practice Address - Street 1:6055 MEXICO RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1632
Practice Address - Country:US
Practice Address - Phone:636-294-2694
Practice Address - Fax:636-222-9277
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024011119101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional