Provider Demographics
NPI:1497954580
Name:FAGAN, PATRICK L (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:L
Last Name:FAGAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 BOBOLINK AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-1513
Mailing Address - Country:US
Mailing Address - Phone:541-607-2728
Mailing Address - Fax:
Practice Address - Street 1:1234 PEARL ST
Practice Address - Street 2:SUITE 3
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3642
Practice Address - Country:US
Practice Address - Phone:541-968-7424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)