Individual
MS. TARI LYNN HAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
1331 GUSDORF ROAD, TAOS, NM 87571
(505) 758-9412
(505) 751-4688
Mailing address
PO BOX 575, TAOS, NM 87571-0575
(505) 751-1056
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I3935
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
76377717
—
NM
Enumeration date
03/12/2007
Last updated
07/09/2007
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