Provider Demographics
NPI:1871996868
Name:MCCOOL, FAWN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:FAWN
Middle Name:
Last Name:MCCOOL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9370 SW GREENBURG RD STE 321
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5421
Mailing Address - Country:US
Mailing Address - Phone:503-496-6712
Mailing Address - Fax:
Practice Address - Street 1:9370 SW GREENBURG RD STE 321
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5421
Practice Address - Country:US
Practice Address - Phone:503-496-6712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL6260101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health