Provider Demographics
NPI:1245740687
Name:WAGNER, JAMES (LMFT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:WAGNER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 7TH ST SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-1112
Mailing Address - Country:US
Mailing Address - Phone:612-824-7748
Mailing Address - Fax:
Practice Address - Street 1:2324 UNIVERSITY AVE W STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-8759
Practice Address - Country:US
Practice Address - Phone:651-641-1009
Practice Address - Fax:651-789-5677
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3318106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist