Provider Demographics
NPI:1336011535
Name:FAGAN, MATTHEW PAUL JR (MS, LPC-ASSOCIATE)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:PAUL
Last Name:FAGAN
Suffix:JR
Gender:M
Credentials:MS, LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7605 MESA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1310
Mailing Address - Country:US
Mailing Address - Phone:512-214-5894
Mailing Address - Fax:
Practice Address - Street 1:7605 MESA DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1310
Practice Address - Country:US
Practice Address - Phone:512-214-5894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX97789101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health