Fagan, Clifford Raymond
Fagan, Clifford Raymond is an sole proprietor health care provider with primary practice located at 800 W Airport Fwy Ste 1100, Irving TX 75062-6312. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Fagan, Clifford Raymond can be contacted via phone (214) 704-5879.Contact Information
Primary practice address
800 W Airport Fwy Ste 1100
Irving TX 75062-6312
Phone: (214) 704-5879
Fax: (888) 974-1492
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 31107 | Texas |
Profile Details
| NPI number | 1053345553 |
|---|---|
| LBN Legal business name | Fagan, Clifford Raymond |
| Credentials | LCSW CCM |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 10th, 2006 |
| Last updated | Feb 10th, 2017 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1053345553 | NPPES |
| Texas | MEDICAID | 1565863-02 | |
| Texas | Other | 66897 |
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