Provider Demographics
NPI:1033565064
Name:HAGEMANN, COURTNEY (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:HAGEMANN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:KUEHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:565 UNION ST NE STE 103
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2416
Mailing Address - Country:US
Mailing Address - Phone:503-316-6770
Mailing Address - Fax:
Practice Address - Street 1:565 UNION ST NE STE 103
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2416
Practice Address - Country:US
Practice Address - Phone:503-316-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
ORT1427106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist