Provider Demographics
NPI:1093239857
Name:FAIR, HAVEN JAMES (BA PSYCHOLOGY)
Entity Type:Individual
Prefix:MR
First Name:HAVEN
Middle Name:JAMES
Last Name:FAIR
Suffix:
Gender:M
Credentials:BA PSYCHOLOGY
Other - Prefix:MR
Other - First Name:HAVEN
Other - Middle Name:JAMES
Other - Last Name:FAIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS ABA
Mailing Address - Street 1:10261 TRADEMARK ST STE C
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5805
Mailing Address - Country:US
Mailing Address - Phone:909-775-8476
Mailing Address - Fax:909-614-8578
Practice Address - Street 1:10261 TRADEMARK ST STE C
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5805
Practice Address - Country:US
Practice Address - Phone:909-317-8499
Practice Address - Fax:909-614-8578
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician