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NPI Code Detail

MEDICARE: ELIZABETH ROSE HAGAN LCPC

MEDICARE: ELIZABETH ROSE HAGAN LCPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor11507NE
2101YM0800XMental Health Counselor6009NV

General Provider Information

NPI Number : 1174015143
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH ROSE HAGAN LCPC
Provider Business Mailing Address
First Line : 2445 FIRE MESA ST STE 190
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-9015
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2445 FIRE MESA ST STE 190
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-9015
Country : US
Telephone Number : 702-456-4262
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2018
Last Update Date : 07/06/2025

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Directions to “ ELIZABETH ROSE HAGAN LCPC” Practice Location

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