Healthcare Provider Details

I. General information

NPI: 1174915151
Provider Name (Legal Business Name): GAIL FAHEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 01/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E FOURTH PLAIN BLVD
VANCOUVER WA
98661-3713
US

IV. Provider business mailing address

1601 E FOURTH PLAIN BLVD
VANCOUVER WA
98661-3713
US

V. Phone/Fax

Practice location:
  • Phone: 360-696-4061
  • Fax:
Mailing address:
  • Phone: 360-696-4061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number4028798
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number33780981
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number60167155
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number4054878
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: