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1316681398
ETHAN WILLIAMS WAGNER
CHICO, CA
NPI
1316681398
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2022-04-25
Last Update Date
2022-04-25
Business Address
Mr. ETHAN WILLIAMS WAGNER
592 RIO LINDO AVE
CHICO, CA 95926-1817
Phone number: 530-891-2775
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Mailing Address
Mr. ETHAN WILLIAMS WAGNER
592 RIO LINDO AVE
CHICO, CA 95926-1817
Phone number: 530-891-2775
Copy
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