Provider Demographics
NPI:1598024911
Name:FAGAN, CATHERINE (LPC, LCDC, LSOTP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:FAGAN
Suffix:
Gender:F
Credentials:LPC, LCDC, LSOTP
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:CATHERINE
Other - Last Name:SLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LCDC, LSOTP
Mailing Address - Street 1:3880 GREENHOUSE RD STE 211
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-6794
Mailing Address - Country:US
Mailing Address - Phone:281-606-9667
Mailing Address - Fax:
Practice Address - Street 1:3880 GREENHOUSE RD STE 211
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-6794
Practice Address - Country:US
Practice Address - Phone:281-606-9667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66988101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE
TX294605503Medicaid