| NPI | 1699854042 |
|---|---|
| Professional Name | G. LANE WAGAMAN |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WV 182) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: WV 182) |
| 103TC0700X Psychologist Clinical (Licence: WV 182) | |
| 103TC1900X Psychologist Counseling (Licence: WV 182) | |
| 103TF0200X Psychologist Forensic (Licence: WV 182) | |
| 103TH0100X Psychologist Health Service (Licence: WV 182) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2010-03-01 |