Provider Demographics
NPI:1750702809
Name:A CLOSER LOOK COUNSELING
Entity type:Organization
Organization Name:A CLOSER LOOK COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-708-1235
Mailing Address - Street 1:631 SPRING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1454
Mailing Address - Country:US
Mailing Address - Phone:541-708-0676
Mailing Address - Fax:541-708-0676
Practice Address - Street 1:631 SPRING CREEK DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1454
Practice Address - Country:US
Practice Address - Phone:541-708-1235
Practice Address - Fax:541-708-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR52511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1962775320OtherOWNER/PRACTITIONER NPI