Healthcare Provider Details

I. General information

NPI: 1982974242
Provider Name (Legal Business Name): TIMI B FAIR MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5306 BALLARD AVE NW STE 322
SEATTLE WA
98107-4366
US

IV. Provider business mailing address

8306 8TH AVE NW TIMI B. FAIR, PSYCHOTHERAPY
SEATTLE WA
98117-3219
US

V. Phone/Fax

Practice location:
  • Phone: 206-706-2839
  • Fax:
Mailing address:
  • Phone: 206-706-2830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60372344
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: