Hagan Black

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CI36260822 Issued in CA

Practice address

9024 Harratt St
West Hollywood, CA 90069-3804

Phone

(323) 640-5282

NPI assigned

Oct 3, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1664755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665014400000",
    "number": "1497479596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "451 INVERNESS DR",
            "city": "LA CANADA FLINTRIDGE",
            "state": "CA",
            "postal_code": "910114144",
            "telephone_number": "323-640-5282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9024 HARRATT ST",
            "city": "WEST HOLLYWOOD",
            "state": "CA",
            "postal_code": "900693804",
            "telephone_number": "323-640-5282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "HAGAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-03",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "CI36260822",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "CI36260822",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11818",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "johnjackson4prez@gmail.com",
            "affiliation": "N",
            "address_1": "9024 Harratt St",
            "city": "West Hollywood",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900693804",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "johnjackson4prez@gmail.com",
            "affiliation": "N",
            "address_1": "9024 Harratt St",
            "city": "West Hollywood",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900693804",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "REST",
            "endpointTypeDescription": "RESTful URL",
            "endpoint": "johnjackson4prez@gmail.com",
            "affiliation": "N",
            "address_1": "9024 Harratt St",
            "city": "West Hollywood",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900693804",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "johnjackson4prez@gmail.com",
            "affiliation": "N",
            "address_1": "9024 Harratt St",
            "city": "West Hollywood",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900693804",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Health Counselor in West Hollywood, CA
• Providers in West Hollywood, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2022; 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.