Provider Demographics
NPI:1043700164
Name:HAGAN, MAUREEN M (LMSW, LCDC)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:M
Last Name:HAGAN
Suffix:
Gender:F
Credentials:LMSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7849 CARIBOU DR
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-4010
Mailing Address - Country:US
Mailing Address - Phone:830-377-7921
Mailing Address - Fax:512-233-1762
Practice Address - Street 1:7849 CARIBOU DR
Practice Address - Street 2:
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-4010
Practice Address - Country:US
Practice Address - Phone:830-377-7921
Practice Address - Fax:512-233-1762
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX658531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical