Provider Demographics
NPI:1306314570
Name:FAGAN, MARJORIE EILEEN (MA LMFT)
Entity type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:EILEEN
Last Name:FAGAN
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29719 MULHOLLAND HWY
Mailing Address - Street 2:
Mailing Address - City:AGOURA
Mailing Address - State:CA
Mailing Address - Zip Code:91301-3005
Mailing Address - Country:US
Mailing Address - Phone:805-300-7570
Mailing Address - Fax:
Practice Address - Street 1:860 HAMPSHIRE RD STE L
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-6017
Practice Address - Country:US
Practice Address - Phone:805-300-7570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109701106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist