Provider Demographics
NPI:1396258414
Name:FAGAN, MARGARET L (LCADC)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:L
Last Name:FAGAN
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:MARTIE
Other - Middle Name:L
Other - Last Name:FAGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCADC
Mailing Address - Street 1:730 N EASTERN AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-2885
Mailing Address - Country:US
Mailing Address - Phone:702-598-2020
Mailing Address - Fax:702-598-2018
Practice Address - Street 1:7 S WATER ST STE A
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7250
Practice Address - Country:US
Practice Address - Phone:702-568-5971
Practice Address - Fax:702-568-5971
Is Sole Proprietor?:No
Enumeration Date:2017-11-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NV00181-LC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health