Provider Demographics
NPI:1255986394
Name:HAGEN, KAITLIN LEE (LMFT)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:LEE
Last Name:HAGEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LEE
Other - Last Name:HAGEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:390 HAVANA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-1904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 S GRAND AVE
Practice Address - Street 2:SUITE #780
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017
Practice Address - Country:US
Practice Address - Phone:562-204-6054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101651106H00000X
CA123087106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist