Provider Demographics
NPI:1134315476
Name:WAGNER, CHRISTAL L (MS, PLMHP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTAL
Middle Name:L
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MS, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 W Q ST APT 16
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68528-1758
Mailing Address - Country:US
Mailing Address - Phone:402-499-9332
Mailing Address - Fax:
Practice Address - Street 1:2130 W Q ST APT 16
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68528-1758
Practice Address - Country:US
Practice Address - Phone:402-499-9332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8422101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor