Individual
CAALA MARIE FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ECTD, MHPP
Contact information
Practice address
1510 BYRUM RD, BLYTHEVILLE, AR 72315-8033
(870) 532-2609
Mailing address
1510 BYRUM RD, BLYTHEVILLE, AR 72315-8033
(870) 532-2609
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/28/2010
Last updated
06/28/2010
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