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General NPI Number Information
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NPI Number | 1104985365
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Entity Type | Individual
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Provider Name | HEIDI LORENE PHAIR M.A.
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Gender | Female
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2703 JAHN AVE. NW SUITE C4
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City | GIG HARBOR
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State | WA
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Zip | 98335
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Country | US
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Telephone | 253-514-2367
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Fax | 253-851-6199
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Provider Business Mailing Address
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Address Line | 2703 JAHN AVE. NW SUITE C4
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City | GIG HARBOR
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State | WA
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Zip | 98335
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Country | US
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Telephone | 253-514-2367
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Fax | 253-851-6199
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 020705LF00000802
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License Number State | WA
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