Active NPI
Kevin Dwayne Bagwell, LPC
- Professional Counselor
- Pasadena, CA
National Provider Identifier
1710010152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 17520
- Practice address
- 75 W Holly St Unit 3010
Pasadena, CA 91103-0309 - Phone
- (231) 633-3400
- NPI assigned
- Mar 14, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 17520 | CA | |
| Mental Health Counselor | 101YM0800X | 6401009233 | MI | |
| Professional Counselor | 101YP2500X | 17520 | CA | Primary |
Addresses
Primary practice location
75 W Holly St Unit 3010
Pasadena, CA 91103-0309
Mailing address
75 W Holly St Unit 3010
Pasadena, CA 91103-0309
Phone (231) 633-3400
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 |
|---|---|---|---|
| 6401009233 | MI | MD | Mental Health Counselor |
| 17520 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756425600000",
"number": "1710010152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 W HOLLY ST UNIT 3010",
"city": "PASADENA",
"state": "CA",
"postal_code": "911030309",
"telephone_number": "231-633-3400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 W HOLLY ST UNIT 3010",
"city": "PASADENA",
"state": "CA",
"postal_code": "911030309",
"telephone_number": "231-633-3400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAGWELL",
"first_name": "KEVIN",
"middle_name": "DWAYNE",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-14",
"last_updated": "2025-08-29",
"certification_date": "2025-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "17520",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MI",
"license": "6401009233",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CA",
"license": "17520",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.