Provider Demographics
NPI:1881494904
Name:WAGNER, ALLISON JEAN (LMHC)
Entity type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:JEAN
Last Name:WAGNER
Suffix:
Gender:
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 GRAND CYPRESS CIR E
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-2343
Mailing Address - Country:US
Mailing Address - Phone:954-881-6543
Mailing Address - Fax:
Practice Address - Street 1:6130 GRAND CYPRESS CIR E
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-2343
Practice Address - Country:US
Practice Address - Phone:954-881-6543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5831101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health