Active NPI
Pamela Fagan, M.A., LCPC
- Mental Health Counselor
- Boise, ID
National Provider Identifier
1104093061
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LCPC-4674
- Practice address
- 13923 W Wainwright Dr Ste 302
Boise, ID 83713-1969 - Phone
- (208) 724-8598
- NPI assigned
- May 9, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LCPC-4674 | ID | Primary |
Addresses
Primary practice location
13923 W Wainwright Dr Ste 302
Boise, ID 83713-1969
Mailing address
13599 W Elmspring St
Boise, ID 83713-1389
Phone (208) 724-8598
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCPC-4674 | ID | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1298332800000",
"number": "1104093061",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13599 W ELMSPRING ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837131389",
"telephone_number": "208-724-8598"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13923 W WAINWRIGHT DR STE 302",
"city": "BOISE",
"state": "ID",
"postal_code": "837131969",
"telephone_number": "208-724-8598"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAGAN",
"first_name": "PAMELA",
"credential": "M.A., LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-09",
"last_updated": "2011-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "ID",
"license": "LCPC-4674",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.