Provider Demographics
NPI:1154876357
Name:HAGEN, TERI A (LPC, BCN)
Entity type:Individual
Prefix:MS
First Name:TERI
Middle Name:A
Last Name:HAGEN
Suffix:
Gender:F
Credentials:LPC, BCN
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:ANN
Other - Last Name:HAGEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCN, BCN
Mailing Address - Street 1:1200 CAMP HILL BYP.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011
Mailing Address - Country:US
Mailing Address - Phone:717-205-2332
Mailing Address - Fax:717-545-1948
Practice Address - Street 1:1200 CAMP HILL BYP STE 300
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-3700
Practice Address - Country:US
Practice Address - Phone:717-205-2332
Practice Address - Fax:717-545-1948
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3672894OtherHIGHMARK
PA103295191.003Medicaid