Provider Demographics
NPI:1306549696
Name:MICHAELA HAGERTY-KOLLER P.S.
Entity type:Organization
Organization Name:MICHAELA HAGERTY-KOLLER P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGERTY-KOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHCA
Authorized Official - Phone:206-588-6409
Mailing Address - Street 1:5413 MERIDIAN AVE N STE A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6166
Mailing Address - Country:US
Mailing Address - Phone:206-588-6409
Mailing Address - Fax:
Practice Address - Street 1:5413 MERIDIAN AVE N STE A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6166
Practice Address - Country:US
Practice Address - Phone:206-588-6409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-24
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health