Individual
MRS. SUSAN MARIE FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.C., R.N.
Contact information
Practice address
12125 WOODCREST EXECUTIVE DR, SUITE 110, SAINT LOUIS, MO 63141-5001
(314) 275-8599
Mailing address
10820 SUNSET OFFICE DR, SUITE 122, SAINT LOUIS, MO 63127-1016
(314) 954-6553
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2004032923
MO
Other
Enumeration date
09/09/2008
Last updated
10/20/2008
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