Provider Demographics
NPI:1912181835
Name:HAGEMYER, TRINA M (MA, PC, CR)
Entity Type:Individual
Prefix:MS
First Name:TRINA
Middle Name:M
Last Name:HAGEMYER
Suffix:
Gender:F
Credentials:MA, PC, CR
Other - Prefix:
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Mailing Address - Street 1:822 EAST MERRY ST PSYCHOLOGICAL SERVICES CENTER
Mailing Address - Street 2:300 PSYCHOLOGY BUILDING, BGSU
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43403-0232
Mailing Address - Country:US
Mailing Address - Phone:419-372-2540
Mailing Address - Fax:419-372-2533
Practice Address - Street 1:601 STATE ROUTE 224
Practice Address - Street 2:ST. RITA'S AMBULATORY CARE CENTER
Practice Address - City:GLANDORF
Practice Address - State:OH
Practice Address - Zip Code:45848
Practice Address - Country:US
Practice Address - Phone:419-538-6000
Practice Address - Fax:419-538-6220
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0700161101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0747240Medicaid