Provider Demographics
NPI:1568688760
Name:GAGNON, TRICIA COLTRANE (LPC)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:COLTRANE
Last Name:GAGNON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 WINDING OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-7876
Mailing Address - Country:US
Mailing Address - Phone:469-619-8710
Mailing Address - Fax:
Practice Address - Street 1:3717 WINDING OAKS DR
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-7876
Practice Address - Country:US
Practice Address - Phone:469-619-8710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17860101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional