MEDICARE: DR. GRADY HOAGLUND LMHC

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	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor	LH61118105	WA
3	101Y00000X	Counselor	LH61118105	WA

General Provider Information

NPI Number	:	1467991513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRADY HOAGLUND LMHC

Provider Business Mailing Address
First Line	:	946 ROBERTS RD
Second Line	:
City	:	NEWPORT
State	:	WA
Zip	:	99156-5335
Country	:	US
Telephone Number	:	509-869-4578
Fax Number	:	509-769-5058

Provider Business Practice Location Address
First Line	:	405 W WALNUT ST STE 2
Second Line	:
City	:	NEWPORT
State	:	WA
Zip	:	99156-9388
Country	:	US
Telephone Number	:	509-869-4578
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2017
Last Update Date	:	05/24/2023

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