Healthcare Provider Details

I. General information

NPI: 1588670335
Provider Name (Legal Business Name): LEE M. FAVER, PHD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5927 SE COLUMBIA WAY UNIT 203
VANCOUVER WA
98661-6381
US

IV. Provider business mailing address

5927 SE COLUMBIA WAY UNIT 203
VANCOUVER WA
98661-6381
US

V. Phone/Fax

Practice location:
  • Phone: 603-852-8238
  • Fax:
Mailing address:
  • Phone: 603-852-8238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY 60285535
License Number StateWA

VIII. Authorized Official

Name: DR. LEE M FAVER
Title or Position: PRESIDENT
Credential: PHD ABPP
Phone: 603-852-8238