Provider Demographics
NPI:1386860013
Name:FAHY, DEANNE (LMFT, LPC)
Entity Type:Individual
Prefix:MS
First Name:DEANNE
Middle Name:
Last Name:FAHY
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 SW 11TH AVE STE 729
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2121
Mailing Address - Country:US
Mailing Address - Phone:503-222-1486
Mailing Address - Fax:
Practice Address - Street 1:833 SW 11TH AVE STE 729
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2121
Practice Address - Country:US
Practice Address - Phone:503-222-1486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1990101YP2500X
ORT0530106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist