Healthcare Provider Details

I. General information

NPI: 1144054339
Provider Name (Legal Business Name): KRISTIN HOAGLAND LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHESTNUT ST
BOWLING GREEN KY
42101-2218
US

IV. Provider business mailing address

655 DECLARATION WAY APT 22
BOWLING GREEN KY
42103-7975
US

V. Phone/Fax

Practice location:
  • Phone: 270-904-0055
  • Fax:
Mailing address:
  • Phone: 931-401-6989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number294218
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: