Colleen Fagan, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2014016577 Issued in MO

Practice address

2900 NE 60TH St Ste 205
Gladstone, MO 64119-2091

Phone

(816) 694-0200

Fax

(888) 507-5906

NPI assigned

May 20, 2014

Last updated

Mar 20, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

University of Texas Southwestern Medical School at Dallas, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1400544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773964800000",
    "number": "1972915379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 NE 60TH ST STE 205",
            "city": "GLADSTONE",
            "state": "MO",
            "postal_code": "641192091",
            "telephone_number": "816-694-0200",
            "fax_number": "888-507-5906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 NE 60TH ST STE 205",
            "city": "GLADSTONE",
            "state": "MO",
            "postal_code": "641192091",
            "telephone_number": "816-694-0200",
            "fax_number": "888-507-5906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "COLLEEN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-20",
        "last_updated": "2026-03-20",
        "certification_date": "2026-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2014016577",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "36586",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "2014016577",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "490014954",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Empowered Counseling LLC
• Penny J Engstrom, LCSW
• Kathryn Etter
• Taina Melissa Eveillard
• Samuel O Fadare Jr., MD
• Kendra Fagan, RN
• Faith Healthcare LLC (Faith Home Healthcare)
• Faith Hospice & Palliative Care LLC
• Farmers Agent LLC (Midwest Insurance & Health services)
• Timothy Filliman, DDS

• Clinical Psychologist in Gladstone, MO
• Providers in Gladstone, MO by specialty
• Clinical Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.