Provider Demographics
NPI:1033718242
Name:HAGEN PSYCHIATRY LLC
Entity Type:Organization
Organization Name:HAGEN PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP
Authorized Official - Phone:541-313-8501
Mailing Address - Street 1:2955 N HIGHWAY 97 STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-7559
Mailing Address - Country:US
Mailing Address - Phone:541-313-8501
Mailing Address - Fax:541-241-2363
Practice Address - Street 1:2955 N HIGHWAY 97 STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7559
Practice Address - Country:US
Practice Address - Phone:541-313-8501
Practice Address - Fax:541-241-2363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty