Provider Demographics
NPI:1093223620
Name:FAJANS, DANIEL SAUL
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:SAUL
Last Name:FAJANS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 GARRISON ST NE
Mailing Address - Street 2:STE #2-#880
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4337
Mailing Address - Country:US
Mailing Address - Phone:206-852-9065
Mailing Address - Fax:
Practice Address - Street 1:1314 GARRISON ST NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-447-8477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60823593101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health