Susan Mary Fagin, MENTAL HEALTH COUNSE

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

565 Union St NE Ste 100
Salem, OR 97301-2416

Phone

(971) 719-2440

NPI assigned

Apr 5, 2010

Last updated

Oct 17, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• Susan Mary Fagin Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1270425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665964800000",
    "number": "1730404567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 HIGH ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013660",
            "telephone_number": "503-371-7655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "565 UNION ST NE STE 100",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973012416",
            "telephone_number": "971-719-2440"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "112 E Burnett St",
            "address_purpose": "LOCATION",
            "city": "Stayton",
            "state": "OR",
            "postal_code": "973831735",
            "country_code": "US",
            "telephone_number": "831-594-5225",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "161 High St SE",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973013660",
            "country_code": "US",
            "telephone_number": "503-910-2829",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "460 13th St NE",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973012650",
            "country_code": "US",
            "telephone_number": "503-371-7655",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAGIN",
        "first_name": "SUSAN",
        "middle_name": "MARY",
        "name_prefix": "Mrs.",
        "credential": "MENTAL HEALTH COUNSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-05",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "OR",
            "license": "9215",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01YM0800X-",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0LYM0800X",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "FAGIN",
            "middle_name": "MARY",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Amy Fagin
• Wayne Fagin, LMT
• Urooba Faheem, M.D
• Karie Diana Fahey, MSW, LCSW
• Mary Ann Fahlstrom, MFT 47696
• Kelly Ann Fair, M.D.

• Mental Health Counselor in Salem, OR
• Providers in Salem, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2022; 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.