Healthcare Provider Details

I. General information

NPI: 1225484827
Provider Name (Legal Business Name): JULIA MARIE HAGAN CP 60145139
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24823 PACIFIC HWY S STE 103
KENT WA
98032-5478
US

IV. Provider business mailing address

1210 SW 136TH ST
BURIEN WA
98166-1214
US

V. Phone/Fax

Practice location:
  • Phone: 253-681-0010
  • Fax: 253-681-0014
Mailing address:
  • Phone: 206-257-6750
  • Fax: 206-257-6825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG61389518
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP 60145139
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: