Healthcare Provider Details

I. General information

NPI: 1306812169
Provider Name (Legal Business Name): JODY FAY SWEENEY MS, LMHC, NCC, CSP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: JODY MARIE FAY MS, LMHC, NCC, CSP

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 W RIVERSIDE AVE SUITE 400
SPOKANE WA
99201-1132
US

IV. Provider business mailing address

1124 W RIVERSIDE AVE SUITE 400
SPOKANE WA
99201-1132
US

V. Phone/Fax

Practice location:
  • Phone: 509-455-8819
  • Fax: 509-455-8903
Mailing address:
  • Phone: 509-455-8819
  • Fax: 509-455-8903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00007965
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number69882
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number420895E
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number1167925
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: