Provider Demographics
NPI:1154439248
Name:WAGNER, BARRIE RACHELE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:BARRIE
Middle Name:RACHELE
Last Name:WAGNER
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15849 N 71ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2179
Mailing Address - Country:US
Mailing Address - Phone:480-353-2499
Mailing Address - Fax:602-992-3268
Practice Address - Street 1:15849 N 71ST ST STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2179
Practice Address - Country:US
Practice Address - Phone:480-353-2499
Practice Address - Fax:602-992-3268
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3269103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical