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General NPI Number Information
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NPI Number | 1174915151
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Entity Type | Individual
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Provider Name | GAIL FAHEY M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/27/2015
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Last Update Date | 01/14/2017
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Provider Practice Location Address
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Address Line | 1601 E FOURTH PLAIN BLVD
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City | VANCOUVER
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State | WA
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Zip | 98661-3713
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Country | US
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Telephone | 360-696-4061
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 E FOURTH PLAIN BLVD
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City | VANCOUVER
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State | WA
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Zip | 98661-3713
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Country | US
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Telephone | 360-696-4061
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Fax |
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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 | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 33780981
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | 4054878
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 4028798
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 60167155
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License Number State | WA
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