Individual
PAMELA FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., LCPC
Contact information
Practice address
13923 W WAINWRIGHT DR STE 302, BOISE, ID 83713-1969
(208) 724-8598
Mailing address
13599 W ELMSPRING ST, BOISE, ID 83713-1389
(208) 724-8598
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-4674
ID
Other
Enumeration date
05/09/2008
Last updated
02/22/2011
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