MEDICARE: MS. ERIN R HAGEN LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6461110929	ND

General Provider Information

NPI Number	:	1174006639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERIN R HAGEN LPCC

Provider Business Mailing Address
First Line	:	3239 OAK RIDGE LOOP E
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-8482
Country	:	US
Telephone Number	:	701-478-7199
Fax Number	:	701-478-1763

Provider Business Practice Location Address
First Line	:	3239 OAK RIDGE LOOP E
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-8482
Country	:	US
Telephone Number	:	701-478-7199
Fax Number	:	701-478-1763

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2018
Last Update Date	:	01/08/2021

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