Provider Demographics
NPI:1437768579
Name:FARIS, JOEY DEAN
Entity Type:Individual
Prefix:
First Name:JOEY
Middle Name:DEAN
Last Name:FARIS
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 1:1617 E HERITAGE LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-8509
Mailing Address - Country:US
Mailing Address - Phone:808-729-6307
Mailing Address - Fax:
Practice Address - Street 1:4305 E TRENT AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99212-2339
Practice Address - Country:US
Practice Address - Phone:509-495-1207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA14928019OtherCAQH