| Doctor Name: | KEVIN DWAYNE BAGWELL |
| NPI Number: | 1710010152 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | 6401009233 |
| Business Practice Address: | 400 State Street Oscoda, MI - 487508747 |
| Business Phone Number: | 9899847850 |
| Business Fax Number: | |
| Mailing Address: | 6797 Lakewood Dr, OSCODA |
| State: | MI |
| Postal Code: | 487508747 |
| Phone Number: | 9899847850 |
| Fax Number: | |
| NPI Enumeration Date: | 03/14/2007 |
| NPI Last Update Date: | 03/04/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 6401009233 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |