Provider Demographics
NPI:1144519646
Name:HAGY, CLARISSA LEE (LPC)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:LEE
Last Name:HAGY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 DARBY CREEK RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509
Mailing Address - Country:US
Mailing Address - Phone:859-338-0466
Mailing Address - Fax:859-294-0802
Practice Address - Street 1:501 DARBY CREEK RD,
Practice Address - Street 2:SUITE 1
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509
Practice Address - Country:US
Practice Address - Phone:859-338-0466
Practice Address - Fax:859-294-0802
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1135101YP2500X
KY1523101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional