Provider Demographics
NPI:1508193301
Name:FAY, BARBARA (LMHC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:FAY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2427 TAMARACK DRIVE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-9365
Mailing Address - Country:US
Mailing Address - Phone:563-380-1895
Mailing Address - Fax:
Practice Address - Street 1:2427 TAMARACK DRIVE RD
Practice Address - Street 2:SUITE B
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-9365
Practice Address - Country:US
Practice Address - Phone:563-380-1895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA# 00950OtherLICENSURE