Provider Demographics
NPI:1972329571
Name:HAGG, STEPHEN LADISLAV (LPC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LADISLAV
Last Name:HAGG
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 BROOKTREE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9272
Mailing Address - Country:US
Mailing Address - Phone:724-719-2669
Mailing Address - Fax:
Practice Address - Street 1:6500 BROOKTREE RD STE 210
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9272
Practice Address - Country:US
Practice Address - Phone:724-719-2669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-27
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC017657101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC017657OtherPA BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS