Provider Demographics
NPI:1144775644
Name:LEE M. FAVER, PHD PLLC
Entity Type:Organization
Organization Name:LEE M. FAVER, PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED BOARD CERTIFIED PSYCHOLOGI
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:FAVER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD ABPP
Authorized Official - Phone:360-524-3616
Mailing Address - Street 1:5927 SE COLUMBIA WAY UNIT 203
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-6381
Mailing Address - Country:US
Mailing Address - Phone:360-524-3616
Mailing Address - Fax:
Practice Address - Street 1:1220 MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2953
Practice Address - Country:US
Practice Address - Phone:360-524-3616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60285535103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty