Provider Demographics
NPI:1144653031
Name:HAGIN, RUTHIE MARIE
Entity type:Individual
Prefix:
First Name:RUTHIE
Middle Name:MARIE
Last Name:HAGIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2671
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-2671
Mailing Address - Country:US
Mailing Address - Phone:214-886-7844
Mailing Address - Fax:
Practice Address - Street 1:1350 N BUCKNER BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3500
Practice Address - Country:US
Practice Address - Phone:214-886-7844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72690101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional