Provider Demographics
NPI:1417202912
Name:HAGAN, JESSICA RENAE (MSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENAE
Last Name:HAGAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 S YALE AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5743
Mailing Address - Country:US
Mailing Address - Phone:918-492-2554
Mailing Address - Fax:918-499-1598
Practice Address - Street 1:7010 S YALE AVE
Practice Address - Street 2:STE 215
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136
Practice Address - Country:US
Practice Address - Phone:918-492-2554
Practice Address - Fax:918-499-1598
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health