MEDICARE: DR. LEE MITCHELL FAVER PHD ABPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	PY 60285535	WA
2	103TC1900X	Counseling Psychologist	PY60285535	WA

General Provider Information

NPI Number	:	1518964824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE MITCHELL FAVER PHD ABPP

Provider Business Mailing Address
First Line	:	5927 SE COLUMBIA WAY UNIT 203
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98661-6381
Country	:	US
Telephone Number	:	360-524-3616
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 WASHINGTON ST STE 1040
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98660-3455
Country	:	US
Telephone Number	:	360-524-3616
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	02/10/2026

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