Provider Demographics
NPI:1760748750
Name:FAGIN, ANDREW (LPC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:FAGIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-4713
Mailing Address - Country:US
Mailing Address - Phone:918-693-5201
Mailing Address - Fax:
Practice Address - Street 1:6717 S YALE AVE STE 202
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3328
Practice Address - Country:US
Practice Address - Phone:918-693-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2019-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional