Susan Marie Fagan, L.P.C., R.N.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

2004032923 Issued in MO

Practice address

12125 Woodcrest Executive Dr
Suite 110
Saint Louis, MO 63141-5001

Phone

(314) 275-8599

NPI assigned

Sep 9, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224460800000",
    "number": "1043468556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10820 SUNSET OFFICE DR",
            "address_2": "SUITE 122",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631271016",
            "telephone_number": "314-954-6553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12125 WOODCREST EXECUTIVE DR",
            "address_2": "SUITE 110",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415001",
            "telephone_number": "314-275-8599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "SUSAN",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "L.P.C., R.N.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-09-09",
        "last_updated": "2008-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MO",
            "license": "2004032923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ruaa Mamoun Suliman Fadl, M.D.
• Karen Faerber, LPS
• Christina Marie Fagan, MSW,LCSW
• David B Fagan, M.D.
• Leonard F Fagan, M.D.
• Timothy D Fagen, D.O.
• Johnathan Schnee Fagg, MD
• Louis Faggetti
• Carye Fagin
• Humberto M Fagundes, MD

• Mental Health Counselor in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Mental Health Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.