Provider Demographics
NPI:1174564892
Name:HAGAN, TARA MAE (MS, LPCC-S)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:MAE
Last Name:HAGAN
Suffix:
Gender:F
Credentials:MS, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 PUBLIC SQ STE 255
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-3298
Mailing Address - Country:US
Mailing Address - Phone:937-216-5290
Mailing Address - Fax:
Practice Address - Street 1:405 PUBLIC SQ STE 255
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-3298
Practice Address - Country:US
Practice Address - Phone:937-216-5290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE4007101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor