Provider Demographics
NPI:1225286545
Name:HAGANS, CASIE MICHELLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CASIE
Middle Name:MICHELLE
Last Name:HAGANS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 COUNTY ROAD 130
Mailing Address - Street 2:
Mailing Address - City:BONO
Mailing Address - State:AR
Mailing Address - Zip Code:72416-8283
Mailing Address - Country:US
Mailing Address - Phone:870-815-1234
Mailing Address - Fax:844-232-7847
Practice Address - Street 1:1150 E MATTHEWS AVE STE 203
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4345
Practice Address - Country:US
Practice Address - Phone:870-815-1234
Practice Address - Fax:844-232-7847
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4161-C1041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5FF19OtherBCBS
AR171512795Medicaid
AR171512795Medicaid