Eileen Jewell Fagan, MS, NCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

C4069 Issued in OR

Practice address

339 SW Century Dr Ste 201
Bend, OR 97702

Phone

(541) 508-9354

NPI assigned

Apr 4, 2013

Sex

Female

Sole proprietor

No

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

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Transformation Counseling

  • Professional Counselor
  • Bend, OR
  • NPI 1366098261
  NPD Authorized official

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

{
    "created_epoch": "1365033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565827200000",
    "number": "1285977553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3616 SW REINDEER AVE",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977567953",
            "telephone_number": "541-508-9354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 SW CENTURY DR STE 201",
            "city": "BEND",
            "state": "OR",
            "postal_code": "97702",
            "telephone_number": "541-508-9354"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1569 SW Nancy Way",
            "address_purpose": "LOCATION",
            "city": "Bend",
            "state": "OR",
            "postal_code": "977023234",
            "country_code": "US",
            "telephone_number": "541-617-0377",
            "fax_number": "541-617-0377",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2275 NE Doctors Dr",
            "address_2": "Suite #1",
            "address_purpose": "LOCATION",
            "city": "Bend",
            "state": "OR",
            "postal_code": "977016324",
            "country_code": "US",
            "telephone_number": "541-323-5515",
            "fax_number": "541-323-3505",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "339 SW Century Dr Ste 201",
            "address_purpose": "LOCATION",
            "city": "Bend",
            "state": "OR",
            "postal_code": "97702",
            "country_code": "US",
            "telephone_number": "541-508-9354",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "EILEEN",
        "middle_name": "JEWELL",
        "credential": "MS, NCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-04",
        "last_updated": "2019-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C4069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eyemart Express LLC
• Eyeonian LLC Dba Eyes on Wall
• Eyes in Motion
• Amber Faast
• Facial and Oral Surgery Center LLC
• Willaim Thomas Fagan, LPC
• Cory Fagin
• Amberena Louise Fairlee, DMD
• Kathryn Fairman
• Cora Faith

• Professional Counselor in Bend, OR
• Providers in Bend, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2019; 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.