Provider Demographics
NPI:1902326861
Name:PAGAN, BRIAN ODELL (LMHC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:ODELL
Last Name:PAGAN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:ODELL
Other - Last Name:PAGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC, CAP
Mailing Address - Street 1:4400 N FEDERAL HWY STE 210
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-5195
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4400 N FEDERAL HWY STE 210
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-5195
Practice Address - Country:US
Practice Address - Phone:954-696-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14953101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health