Provider Demographics
NPI:1811588981
Name:GAGNON, DEVIN NICOLE (M ED)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:NICOLE
Last Name:GAGNON
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2054 CLEARMIST WAY
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-2430
Mailing Address - Country:US
Mailing Address - Phone:214-578-8744
Mailing Address - Fax:
Practice Address - Street 1:2054 CLEARMIST WAY
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-2430
Practice Address - Country:US
Practice Address - Phone:214-578-8744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-19-97363106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician