Healthcare Provider Details

I. General information

NPI: 1881908101
Provider Name (Legal Business Name): WILLIAM J HAGERTY M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 SEYMOUR AVE
LANSING MI
48933-1185
US

IV. Provider business mailing address

335 SEYMOUR AVE
LANSING MI
48933-1185
US

V. Phone/Fax

Practice location:
  • Phone: 517-482-2800
  • Fax: 517-482-7237
Mailing address:
  • Phone: 517-482-2800
  • Fax: 517-482-7237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401011974
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: