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

Kellie Wagner, LAC

Individual provider Mental Health Counselor · NPI 1760267165

Kellie Wagner, LAC is a Mental Health Counselor in Scottsdale, Arizona. Qualified in 2022, 4 years ago. Licensed in Arizona.

Years since qualifying
4
Licensed in
AZ
In the registry since
2023
What do these letters mean?
LAC — Licensed Associate Counselor
A counsellor practising under supervision toward full licensure. In some states the same letters mean Licensed Acupuncturist.

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Practice location Address checks out

10901 E McDowell Rd
Scottsdale, AZ 85256-5300
Phone: (480) 362-2603
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence LAC-21955 (AZ)

Record details

NPI number1760267165
Entity typeIndividual (Type 1)
GenderFemale
Credentials LAC
Sole proprietorNo
NPI enumeratedAugust 25, 2023
Last updated in NPPESAugust 25, 2023
Certification dateAugust 25, 2023

Medicare enrollment

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

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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