Provider Demographics
NPI:1679912869
Name:WAGNER-ANGEL, ANNE MARIE (LMHC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:WAGNER-ANGEL
Suffix:
Gender:F
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:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561-1933
Mailing Address - Country:US
Mailing Address - Phone:574-210-7517
Mailing Address - Fax:
Practice Address - Street 1:1415 LINCOLNWAY W
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IN
Practice Address - Zip Code:46561-2062
Practice Address - Country:US
Practice Address - Phone:574-651-8912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002936A101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health