Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Souphaphone Hagan

Individual provider Clinical Social Worker · NPI 1205466570

Souphaphone Hagan is a Clinical Social Worker in Fresno, California. Qualified in 2015, 11 years ago. Practices with Thriveworks Clinical - California PC, a 54-clinician group, accepts Medicare assignment and offers telehealth. Licensed in California.

Years since qualifying
11
Licensed in
CA
In the registry since
2020
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Practice location Address checks out

496 S Barton Ave
Fresno, CA 93702-2985
Phone: (559) 860-4422
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 107193 (CA)

Record details

NPI number1205466570
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJanuary 24, 2020
Last updated in NPPESSeptember 11, 2023
Certification dateAugust 31, 2023
Mailing address516 Villa Ave Ste 2, Clovis, CA 93612-0899

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Thriveworks Clinical - California Pc — 54 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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