Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 77801 | TX |
N | 101YM0800X | Mental Health Counselor | 77801 | TX |
N | 101YP2500X | Professional Counselor | 77801 | TX |
N | 101YS0200X | School Counselor | 1772725 | TX |
NPI | 1114581196 |
---|---|
Provider Name | Robin Wagner |
First Address | Houston, TX 77046-3616 |
Second Address | Houston, TX 77046-3616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2019 |
Last Update Date | 25/04/2019 |