Provider Demographics
NPI:1578081683
Name:HAGLUND, KYRA (LCSW)
Entity Type:Individual
Prefix:
First Name:KYRA
Middle Name:
Last Name:HAGLUND
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 1:210 N EDGEMONT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-6258
Mailing Address - Country:US
Mailing Address - Phone:1310-279-7284
Mailing Address - Fax:
Practice Address - Street 1:8170 BEVERLY BLVD STE 700
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4524
Practice Address - Country:US
Practice Address - Phone:310-279-7284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA765601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical