Wagoner, Derrick

Wagoner, Derrick is an individual health care provider with primary practice located at 104 Reynolds Rd , Glasgow KY 42141-1177. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is his primary health care specialty. Wagoner, Derrick can be contacted via phone (270) 678-4801.

Contact Information

Primary practice address
104 Reynolds Rd Glasgow KY 42141-1177
Phone: (270) 678-4801
Fax: (270) 678-3866
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 1839 Kentucky
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 172294 Kentucky

Profile Details

NPI number 1033529813
LBN Legal business name Wagoner, Derrick
Credentials LPCC
Entity Individual
Sole proprietor 1 No
Enumeration date May 2nd, 2014
Last updated May 12th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Popular Providers