Healthcare Provider Details

I. General information

NPI: 1245676600
Provider Name (Legal Business Name): KIMBERLY CROWELL HAGLER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 BROADWAY ST
VANCOUVER WA
98663-3327
US

IV. Provider business mailing address

2012 BROADWAY ST
VANCOUVER WA
98663-3327
US

V. Phone/Fax

Practice location:
  • Phone: 503-819-4859
  • Fax:
Mailing address:
  • Phone: 503-819-4859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60421993
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC3109
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701002674
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717000569
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: