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General NPI Number Information
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NPI Number | 1407220494
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Entity Type | Organization
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Legal Business Name | PENSACOLA COUNSELOR LLC
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Dates
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Enumeration Date | 11/14/2015
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Last Update Date | 11/14/2015
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Provider Practice Location Address
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Address Line | 4300 BAYOU BLVD SUITE 21
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City | PENSACOLA
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State | FL
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Zip | 32503-1949
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Country | US
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Telephone | 850-462-3595
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Fax | 850-607-2771
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Provider Business Mailing Address
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Address Line | 4300 BAYOU BLVD SUITE 21
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City | PENSACOLA
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State | FL
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Zip | 32503-1949
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Country | US
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Telephone | 850-462-3595
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Fax | 850-607-2771
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | REGAN HAGER
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Credential | LMHC
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Telephone | 850-462-3595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH12078
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License Number State | FL
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