Susan Jane Hagen, LCPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

1104 Issued in MT

Practice address

410 Windward Way
Kalispell, MT 59901-2680

Phone

(406) 257-1336

Fax

(406) 257-1353

NPI assigned

Dec 21, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Susan Gjesdal Hagen Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Western Montana Mental Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Missoula, MT
  • NPI 1912079328
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260835200000",
    "number": "1043374200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 WINDWARD WAY",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599012680",
            "telephone_number": "406-257-1336",
            "fax_number": "406-257-1353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 WINDWARD WAY",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599012680",
            "telephone_number": "406-257-1336",
            "fax_number": "406-257-1353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGEN",
        "first_name": "SUSAN",
        "middle_name": "JANE",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-21",
        "last_updated": "2009-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MT",
            "license": "1104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000255527",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "HAGEN",
            "middle_name": "GJESDAL",
            "credential": "LCPC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Tom Gutschenritter, LCSW
• DC Haas
• David Habel, M.D.
• Colton Bragg Hackley, LCPC
• Piper L Hadley, ACLC
• Laurie Halfast, M.S., CCC-SLP
• Nathaniel Lyle Hall, M.D.
• Yvonne Hall
• Jeffrey Leonard Halleck, M.D.
• Maura Sue Hamilton, CPNP

• All providers in Kalispell, MT
• Mental Health Counselor in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.