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General NPI Number Information
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NPI Number | 1912843236
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Entity Type | Individual
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Provider Name | ERIN FAVA
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Gender | Female
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Dates
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Enumeration Date | 04/28/2026
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Last Update Date | 04/28/2026
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Provider Practice Location Address
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Address Line | 2559 MERRIMAN RD
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City | MEDFORD
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State | OR
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Zip | 97501-1260
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Country | US
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Telephone | 541-237-0053
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Fax | 541-200-3450
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Provider Business Mailing Address
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Address Line | 1750 NEBRASKA AVE BLDG A
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City | GRANTS PASS
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State | OR
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Zip | 97527-5700
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Country | US
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Telephone | 541-244-8557
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Fax | 541-244-8557
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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