Individual
KEVIN DWAYNE BAGWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
75 W HOLLY ST UNIT 3010, PASADENA, CA 91103-0309
(231) 633-3400
Mailing address
75 W HOLLY ST UNIT 3010, PASADENA, CA 91103-0309
(231) 633-3400
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
17520
CA
101YM0800X
Mental Health Counselor
6401009233
MI
101YP2500X
Professional Counselor
Primary
17520
CA
Other
Enumeration date
03/14/2007
Last updated
08/29/2025
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