Doctor Name: | MR. ERIC DANIEL PAGAN |
NPI Number: | 1043694748 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 2013011393 |
Business Practice Address: | 22145 Kafir Rd Oronogo, MO - 648559141 |
Business Phone Number: | 4176730090 |
Business Fax Number: | 4176734349 |
Mailing Address: | 22145 Kafir Rd, ORONOGO |
State: | MO |
Postal Code: | 648559141 |
Phone Number: | 4176730090 |
Fax Number: | 4176734349 |
NPI Enumeration Date: | 07/13/2015 |
NPI Last Update Date: | 07/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2013011393 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |