| Fagan Psychotherapy Pllc | |
|
2605 Prairie Ave Apt 18 Evanston IL 60201-1496 | |
| (312) 385-9620 | |
| Not Available |
| Full Name | Fagan Psychotherapy Pllc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2605 Prairie Ave Apt 18, Evanston, Illinois |
| Authorized Official Name and Position | Brian Fagan (OWNER) |
| Authorized Official Contact | 3123859620 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fagan Psychotherapy Pllc 2605 Prairie Ave Apt 18 Evanston IL 60201-1496 Ph: (312) 385-9620 | Fagan Psychotherapy Pllc 2605 Prairie Ave Apt 18 Evanston IL 60201-1496 Ph: (312) 385-9620 |
| NPI Number | 1104511104 |
|---|---|
| Provider Enumeration Date | 04/06/2023 |
| Last Update Date | 04/06/2023 |
| Certification Date | 04/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104511104 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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