Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YM0800X | Mental Health Counselor | ||
Y | 225400000X | Rehabilitation Practitioner | ||
N | 225C00000X | Rehabilitation Counselor |
NPI | 1114594694 |
---|---|
Provider Name | Cheryl L Bagan |
First Address | Los Angeles, CA 90045-6409 |
Second Address | Los Angeles, CA 90043-3615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2021 |
Last Update Date | 15/09/2021 |