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General NPI Number Information
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NPI Number | 1144775644
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Entity Type | Organization
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Legal Business Name | LEE M. FAVER, PHD PLLC
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Dates
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Enumeration Date | 08/25/2016
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Last Update Date | 08/25/2016
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Provider Practice Location Address
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Address Line | 1220 MAIN ST STE 4
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City | VANCOUVER
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State | WA
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Zip | 98660-2953
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Country | US
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Telephone | 360-524-3616
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Fax |
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Provider Business Mailing Address
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Address Line | 5927 SE COLUMBIA WAY UNIT 203
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City | VANCOUVER
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State | WA
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Zip | 98661-6381
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Country | US
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Telephone | 360-524-3616
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Fax |
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Authorized Official
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Title or Position | LICENSED BOARD CERTIFIED PSYCHOLOGI
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Name | DR. LEE MITCHELL FAVER
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Credential | PHD ABPP
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Telephone | 360-524-3616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PY60285535
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License Number State | WA
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