Individual
WILLAIM THOMAS FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1569 SW NANCY WAY, BEND, OR 97702-3234
(541) 617-0377
(541) 617-0377
Mailing address
3616 SW REINDEER AVE, REDMOND, OR 97756-7953
(541) 508-9593
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
R2719
OR
101YP2500X
Professional Counselor
Primary
C4302
OR
Other
Enumeration date
03/04/2013
Last updated
08/15/2019
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