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KELLIE WAGNER LAC
NPI 1760267165
Counselor - Mental Health in Scottsdale, AZ

Active since August 25, 2023PECOS Enrolled
10901 E MCDOWELL RD, SCOTTSDALE, AZ 85256(480) 362-2603 Get Directions Write a Review

NPPES record last updated: August 25, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Kellie Wagner Lac NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLIE WAGNER LAC (NPI 1760267165) is an individual mental health provider in Scottsdale, Arizona, licensed in Arizona (LAC-21955) and active in the NPI registry since August 2023. She is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1760267165
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameKELLIE WAGNERCredential: LAC
Location Address10901 E MCDOWELL RDScottsdale, AZ 85256-5300
Mailing Address10901 E Mcdowell RdScottsdale, AZ 85256-5300 · (480) 362-2603
Phone(480) 362-2603
Sole ProprietorNo
Medical School CMSOtherGraduated 2022
Enumeration DateAugust 25, 2023
NPPES CertifiedAugust 25, 2023
✔ NPI 1760267165 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in AZ · LAC-21955
10901 E MCDOWELL RD, Scottsdale, AZ 85256
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kellie Wagner Lac is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1658725817
PECOS Enrollment IDI20260602000273
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Kellie Wagner reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Salt River Pima-Maricopa Indian Community
0.1 mi
Community/Behavioral Health
10901 E MCDOWELL RD
Scottsdale, AZ 85256
  • Reassigned Medicare billing, Texas enrollment
  • 147 clinicians in this Medicare group
NPI 1497000293 (480) 278-7742

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KIANNA MEMARAN DMD
Dentist
10901 E MCDOWELL RD
SCOTTSDALE, AZ 85256
Maricopa County (480) 278-7742
NASIR ABDUL-BARI LISAC
Counselor (Addiction (Substance Use Disorder))
10901 E MCDOWELL RD
SCOTTSDALE, AZ 85256
Maricopa County (480) 362-3164
MARTHA YVONNE VILLALOBOS
Counselor
10901 E MCDOWELL RD
SCOTTSDALE, AZ 85256
Maricopa County (602) 620-2719
CHRISTINE LE CHAVEZ D.M.D.
Dentist (General Practice)
10901 E MCDOWELL RD
SCOTTSDALE, AZ 85256
Maricopa County (480) 278-7742
KEVIN T WILLIAMS PT, DPT, CSCS
Physical Therapist
10901 E MCDOWELL RD
SCOTTSDALE, AZ 85256
Maricopa County (480) 278-7742
TAYLOR N KUHN PT, DPT
Physical Therapist
10901 E MCDOWELL RD
SCOTTSDALE, AZ 85256
Maricopa County (480) 278-7742
TESSA EMILY SHORTY-SMITH RDH
Dental Hygienist
10901 E MCDOWELL RD
SCOTTSDALE, AZ 85256
Maricopa County (480) 362-2603
KATHERINE ALESA TAYLOR MPH, RDN, CDCES
Dietitian, Registered
10901 E MCDOWELL RD
SCOTTSDALE, AZ 85256
Maricopa County (480) 362-3355

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kellie Wagner's NPI number?

The NPI number for Kellie Wagner is 1760267165. It was assigned to this individual provider in the NPPES registry on August 25, 2023.

Where is Kellie Wagner located?

Kellie Wagner practices at 10901 E Mcdowell Rd, Scottsdale, AZ 85256. The listed phone number is (480) 362-2603.

What is Kellie Wagner's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Kellie Wagner enrolled in Medicare?

Yes. Kellie Wagner is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kellie Wagner's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kellie Wagner reassigns Medicare benefits to Salt River Pima-Maricopa Indian Community (Scottsdale, AZ). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kellie Wagner's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Kellie Wagner was last updated on August 25, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.