Provider Demographics
NPI:1083949945
Name:WAGNER, ELIZABETH MAE (MA, NCC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MAE
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4385 S BALSAM ST UNIT 7-201
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80123-4603
Mailing Address - Country:US
Mailing Address - Phone:303-895-7204
Mailing Address - Fax:
Practice Address - Street 1:5984 S PRINCE ST STE 101
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-2083
Practice Address - Country:US
Practice Address - Phone:303-738-1021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor