Pensacola Counselor LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH12078 Issued in FL

Legal business name

PENSACOLA COUNSELOR LLC

Practice address

4300 Bayou Blvd
Suite 21
Pensacola, FL 32503-1949

Phone

(850) 462-3595

Fax

(850) 607-2771

NPI assigned

Nov 14, 2015

Organization subpart

No

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

Authorized official

Name

Regan Hager, LMHC

Title

Owner/President

Phone

(850) 462-3595

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1447459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447459200000",
    "number": "1407220494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 BAYOU BLVD",
            "address_2": "SUITE 21",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325031949",
            "telephone_number": "850-462-3595",
            "fax_number": "850-607-2771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 BAYOU BLVD",
            "address_2": "SUITE 21",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325031949",
            "telephone_number": "850-462-3595",
            "fax_number": "850-607-2771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENSACOLA COUNSELOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-14",
        "last_updated": "2015-11-14",
        "status": "A",
        "authorized_official_last_name": "HAGER",
        "authorized_official_first_name": "REGAN",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "850-462-3595",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH12078",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009764400",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009812400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2015; 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.