Provider Demographics
NPI:1154049740
Name:ASHLEY WAGNER COUNSELING PLLC
Entity type:Organization
Organization Name:ASHLEY WAGNER COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:425-448-0132
Mailing Address - Street 1:9805 NE 116TH ST # 7496
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4245
Mailing Address - Country:US
Mailing Address - Phone:425-448-0132
Mailing Address - Fax:
Practice Address - Street 1:19729 170TH AVE NE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-7059
Practice Address - Country:US
Practice Address - Phone:425-448-0132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health