Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Derrick Wagoner, LPCC

Individual provider Professional Counselor · NPI 1033529813

Derrick Wagoner, LPCC is a Mental Health Counselor in Glasgow, Kentucky. Qualified in 2013, 13 years ago. Practices with Kw Consulting LLC, a 28-clinician group, works from 4 locations and accepts Medicare assignment. Licensed in Kentucky.

Years since qualifying
13
Licensed in
KY
In the registry since
2014
Specialties on file
2
What do these letters mean?
LPCC — Licensed Professional Clinical Counselor
The title some states use for a licensed clinical counsellor.

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Practice location Address checks out

104 Reynolds Rd
Glasgow, KY 42141-1177
Phone: (270) 678-4801
Fax: (270) 678-3866
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (3)

  • 1048 Ashley St Ste 201, Bowling Green, KY 42103-2449 — (270) 904-6567
  • 1600 Scottsville Rd Ste 101, Bowling Green, KY 42104-3217 — (270) 904-6567
  • 1910 Lyda Ave, Bowling Green, KY 42104-3326 — (270) 904-6567

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence 172294 (KY)
Professional Counselor Taxonomy 101YP2500X · Licence 1839 (KY)

Record details

NPI number1033529813
Entity typeIndividual (Type 1)
GenderMale
Credentials LPCC
Sole proprietorNo
NPI enumeratedMay 2, 2014
Last updated in NPPESMay 12, 2021
Certification dateMay 12, 2021
Mailing address104 Reynolds Rd, Glasgow, KY 42141-1177

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice Kw Consulting Llc — 28 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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