Active NPI
Ingrid Marie Hagen, MC, LPC, LISAC, NCC
- Professional Counselor
- Tempe, AZ
National Provider Identifier
1205809993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC-11062LISAC-10492
- Practice address
- 1972 E Baseline Rd
Suite B-102
Tempe, AZ 85283-1532 - Phone
- (602) 618-2726
- NPI assigned
- Feb 11, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LISAC-10492 | AZ | |
| Professional Counselor | 101YP2500X | LPC-11062LISAC-10492 | AZ | Primary |
Addresses
Primary practice location
1972 E Baseline Rd
Suite B-102
Tempe, AZ 85283-1532
Mailing address
PO Box 2501
Chandler, AZ 85244-2501
Phone (602) 618-2726
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LISAC-10492 | AZ | MD | Addiction (Substance Use Disorder) Counselor |
| LPC-11062LISAC-10492 | AZ | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139616000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571270400000",
"number": "1205809993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2501",
"city": "CHANDLER",
"state": "AZ",
"postal_code": "852442501",
"telephone_number": "602-618-2726"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1972 E BASELINE RD",
"address_2": "SUITE B-102",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852831532",
"telephone_number": "602-618-2726"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAGEN",
"first_name": "INGRID",
"middle_name": "MARIE",
"credential": "MC, LPC, LISAC, NCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-02-11",
"last_updated": "2019-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "AZ",
"license": "LISAC-10492",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AZ",
"license": "LPC-11062LISAC-10492",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tempe, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.