Provider Demographics
NPI:1699961284
Name:KAGAN, ILONA (LMHC)
Entity type:Individual
Prefix:MRS
First Name:ILONA
Middle Name:
Last Name:KAGAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 KAITLYN ANN CIR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-3472
Mailing Address - Country:US
Mailing Address - Phone:561-716-3745
Mailing Address - Fax:
Practice Address - Street 1:4725 KAITLYN ANN CIR
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-3472
Practice Address - Country:US
Practice Address - Phone:561-716-3745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health