Healthcare Provider Details

I. General information

NPI: 1548970304
Provider Name (Legal Business Name): TIMOTHY HAGER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19320 E ADMIRAL PL STE B
CATOOSA OK
74015-3240
US

IV. Provider business mailing address

2624 E 22ND PL
TULSA OK
74114-3131
US

V. Phone/Fax

Practice location:
  • Phone: 918-340-5503
  • Fax:
Mailing address:
  • Phone: 918-760-1098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: