Provider Demographics
NPI:1205809993
Name:HAGEN, INGRID MARIE (MC, LPC, LISAC, NCC)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:MARIE
Last Name:HAGEN
Suffix:
Gender:F
Credentials:MC, LPC, LISAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2501
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85244-2501
Mailing Address - Country:US
Mailing Address - Phone:602-618-2726
Mailing Address - Fax:
Practice Address - Street 1:1972 E BASELINE RD
Practice Address - Street 2:SUITE B-102
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1532
Practice Address - Country:US
Practice Address - Phone:602-618-2726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-11
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10492101YA0400X
AZLPC-11062LISAC-10492101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)