MEDICARE: COLLIN HAGOOD, LPC

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
1	101YP2500X	Professional Counselor	63989	TX

General Provider Information

NPI Number	:	1376850602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLIN HAGOOD, LPC

Provider Business Mailing Address
First Line	:	2608 STATE ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-2600
Country	:	US
Telephone Number	:	903-821-3630
Fax Number	:

Provider Business Practice Location Address
First Line	:	2608 STATE ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-2600
Country	:	US
Telephone Number	:	903-821-3630
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	COLLIN MATTHEW HAGOOD
Credential	:	LPC
Telephone Number	:	903-821-3630

Provider Enumeration Date	:	09/08/2010
Last Update Date	:	09/08/2010

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