Provider Demographics
NPI:1265836076
Name:HAGOS, YOHANNES
Entity Type:Individual
Prefix:
First Name:YOHANNES
Middle Name:
Last Name:HAGOS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:YOHANNES
Other - Middle Name:
Other - Last Name:HAGOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MASTER
Mailing Address - Street 1:15 S. GRADY WAY
Mailing Address - Street 2:310
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057
Mailing Address - Country:US
Mailing Address - Phone:206-726-0430
Mailing Address - Fax:206-726-0436
Practice Address - Street 1:15 S. GRADY WAY
Practice Address - Street 2:310
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057
Practice Address - Country:US
Practice Address - Phone:206-726-0430
Practice Address - Fax:206-726-0436
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60183954101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health