Provider Demographics
NPI:1225484827
Name:HAGAN, JULIA MARIE (CP 60145139)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:MARIE
Last Name:HAGAN
Suffix:
Gender:F
Credentials:CP 60145139
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 SW 136TH ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1214
Mailing Address - Country:US
Mailing Address - Phone:206-257-6750
Mailing Address - Fax:206-257-6825
Practice Address - Street 1:24823 PACIFIC HWY S STE 103
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5478
Practice Address - Country:US
Practice Address - Phone:253-681-0010
Practice Address - Fax:253-681-0014
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61389518101YM0800X
WACP 60145139101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health