Provider Demographics
NPI:1578233813
Name:AEGIS COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:AEGIS COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRADY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOAGLUND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-869-4578
Mailing Address - Street 1:946 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156-5335
Mailing Address - Country:US
Mailing Address - Phone:509-869-4578
Mailing Address - Fax:
Practice Address - Street 1:405 W WALNUT ST STE 2
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156-9388
Practice Address - Country:US
Practice Address - Phone:509-869-4578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-17
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty