Individual
MR. CLIFFORD RAYMOND FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW CCM
Contact information
Practice address
800 W AIRPORT FWY, STE 1100, IRVING, TX 75062-6312
(214) 704-5879
(888) 974-1492
Mailing address
800 W AIRPORT FWY, STE 1100, IRVING, TX 75062-6312
(214) 704-5879
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
31107
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1565863-02
—
TX
01
—
66897
CSHCN
TX
Enumeration date
07/10/2006
Last updated
02/10/2017
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