Provider Demographics
NPI:1356069512
Name:HAGANS, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:HAGANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:WASHUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:706 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-1844
Mailing Address - Country:US
Mailing Address - Phone:850-896-3911
Mailing Address - Fax:
Practice Address - Street 1:510 W 10TH ST
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-2329
Practice Address - Country:US
Practice Address - Phone:850-896-3911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician