Provider Demographics
NPI:1053119925
Name:WAGNER, SARAH (MA LMFT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:WAGNER
Suffix:
Gender:
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 WALL ST STE 22
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2572
Mailing Address - Country:US
Mailing Address - Phone:219-928-8211
Mailing Address - Fax:
Practice Address - Street 1:402 WALL ST STE 22
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2572
Practice Address - Country:US
Practice Address - Phone:219-928-8211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN85000529A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist