Provider Demographics
NPI:1730335282
Name:WAGNER, TRICIA LYNN (LCPC, LAC)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:LYNN
Last Name:WAGNER
Suffix:
Gender:F
Credentials:LCPC, LAC
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:LYNN
Other - Last Name:AYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC, LAC
Mailing Address - Street 1:1241 LUCCHESE ROAD
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602
Mailing Address - Country:US
Mailing Address - Phone:406-366-5934
Mailing Address - Fax:
Practice Address - Street 1:505 W MAIN ST
Practice Address - Street 2:SUITE 318
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-5703
Practice Address - Country:US
Practice Address - Phone:406-366-5934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLAC1413101YA0400X
MT1379-LCPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty