Provider Demographics
NPI:1114581196
Name:WAGNER, ROBIN (MED, EDS, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MED, EDS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 RICHMOND AVE APT 127
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-3616
Mailing Address - Country:US
Mailing Address - Phone:713-826-7909
Mailing Address - Fax:
Practice Address - Street 1:3660 RICHMOND AVE APT 127
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77046-3616
Practice Address - Country:US
Practice Address - Phone:713-826-7909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77801101Y00000X, 101YM0800X, 101YP2500X
TX1772725101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional