=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053766998
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. HERB W AGAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2016
-----------------------------------------------------
Last Update Date | 04/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6750 WEST LOOP S 670
-----------------------------------------------------
City | BELLAIRE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77401-4103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-665-5925
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6750 WEST LOOP S 670
-----------------------------------------------------
City | BELLAIRE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77401-4103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-665-5925
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLIGIST
-----------------------------------------------------
Name | DR. HERB WESLEY AGAN
-----------------------------------------------------
Credential | ED.D.
-----------------------------------------------------
Telephone | 713-202-2545
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | TX 2-2678
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------