DERRICK WAGONER (NPI# 1033529813) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033529813 |
| Entity Type | Individual |
| Full Name | DERRICK WAGONER |
| Credential | LPCC |
| Practice Address |
1048 Ashley St Ste 201 Bowling Green KY 42103-2449 |
| Mailing Address |
104 Reynolds Rd Glasgow KY 42141-1177 |
| Practice Telephone | 2709046567 |
| Practice Fax Number | 2709046570 |
| Mailing Telephone | 2706784801 |
| Mailing Fax Number | 2706783866 |
| Enumeration Date | 2014-05-02 |
| Last Update Date | 2017-03-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
172294 | KY | Behavioral Health & Social Service Providers |
| N | 101YP2500X |
Counselor Specialization: Professional |
1839 | KY | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760829220 | Derrick Durell Wagoner | Radiology | 1800 Renaissance Blvd Ste 110, Edmond, OK 73013 | 2013-05-23 |
| Street Address |
1048 ASHLEY ST STE 201 |
| City | BOWLING GREEN |
| State | KY |
| Zip Code | 42103-2449 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780901983 | Derrick A Mason | Marriage & Family Therapist | 1048 Ashley St Ste 201, Bowling Green, KY 42103-2449 | 2010-04-27 |
| 1861802670 | Alysha Ferguson | Social Worker | 1048 Ashley St Ste 201, Bowling Green, KY 42103-2449 | 2014-05-01 |
| 1184034985 | Melynda Amorim | Social Worker | 1048 Ashley St Ste 201, Bowling Green, KY 42103-2449 | 2014-05-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679127781 | Kw Consulting, LLC | Counselor | 1054 Searcy Way, Suite E, Bowling Green, KY 42103 | 2019-07-26 |
| 1063999662 | Southern Kentucky Surgicenter, LLC | Clinic/Center | 484 Golden Autumn Way, Suite 100, Bowling Green, KY 42103 | 2018-07-26 |
| 1780170936 | Midsouth Psychological Services, LLC | Psychologist | 996 Wilkinson Trce Ste A8, Bowling Green, KY 42103 | 2018-07-10 |
| 1760976146 | Prorehab Inc | Clinic/Center | 1110 Wilkinson Trce Ste 101, Bowling Green, KY 42103 | 2018-06-19 |
| 1063927671 | James Toney | Counselor | 624 Eastwood St, Bowling Green, KY 42103 | 2017-12-05 |
| 1366979528 | Laura Elizabeth Compton | Optometrist | 335 New Towne Drive, Bowling Green, KY 42103 | 2017-05-18 |
| 1033562632 | Elizabette Raby | Massage Therapist | 427 Us-31 Bypass, Suite 203, Bowling Green, KY 42103 | 2016-07-19 |
| 1831572460 | Casey Edward Travelsted | Dentist | 940 Us 31 W Bypass, Bowling Green, KY 42103 | 2015-07-01 |
| 1821435074 | Robert Louis Skaggs II | Dermatology | 1818 Wallace Court, Suite 301, Bowling Green, KY 42103 | 2013-05-29 |
| 1770893257 | Michelle Howell | Health Educator | 261 Moats Lane, Bowling Green, KY 42103 | 2010-10-18 |
| Find all providers in zip 42103 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255957890 | Ashleigh Rashell Emberton | Counselor | 1300 Andrea St Ste 204, Bowling Green, KY 42104-3382 | 2020-06-19 |
| 1467099135 | Aspire Mentoring Foundation LLC | Counselor | 1501 Normalview Dr, Bowling Green, KY 42101-2834 | 2019-12-02 |
| 1336706902 | Alice J Beckner | Counselor | 624 Oaklawn Way, Bowling Green, KY 42104-3867 | 2019-05-20 |
| 1083279715 | Telehealth Counseling of Ky, LLC | Counselor | 429 Adalynn Cir, Bowling Green, KY 42104-0001 | 2019-05-08 |
| 1174003032 | Leah Marie Gomez | Counselor | 221 S Church St Ste 200, Bowling Green, OH 43402-2816 | 2018-08-20 |
| 1306397476 | Nnennaya Njoku | Counselor | 299 Westwood Ave, Bowling Green, KY 42103-9066 | 2016-10-24 |
| 1760864060 | Catherine Crawford | Counselor | 1084 S Main St Ste A, Bowling Green, OH 43402-4740 | 2015-06-23 |
| 1629491576 | Reba Mcginnis | Counselor | 918 State St, 2nd Floor, Bowling Green, KY 42101-2233 | 2014-01-29 |
| 1922442367 | Mary Howard Higgins | Counselor | 424 Hammett Hill Rd, Bowling Green, KY 42101-8244 | 2013-04-27 |
| 1740585082 | Sfreeman Inc. | Counselor | 724 E. 11th Street, Bowling Green, KY 42101-2508 | 2011-01-18 |
| Find all providers in BOWLING GREEN | ||||
| City | BOWLING GREEN |
| Zip Code | 42103 |
Please comment or provide details below to improve the information on DERRICK WAGONER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.