Healthcare Provider Details

I. General information

NPI: 1780098186
Provider Name (Legal Business Name): FAY JAMES-ASHLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 TEXAS ST STE. 701
HOUSTON TX
77002-3512
US

IV. Provider business mailing address

1314 TEXAS ST STE 701
HOUSTON TX
77002-3522
US

V. Phone/Fax

Practice location:
  • Phone: 832-819-4211
  • Fax: 888-457-1412
Mailing address:
  • Phone: 832-819-4211
  • Fax: 888-457-1412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number28213
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number28213
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28213
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number28213
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: