Provider Demographics
NPI:1518403898
Name:FAURBO, LEAH ANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:ANNE
Last Name:FAURBO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1008
Mailing Address - Country:US
Mailing Address - Phone:559-978-9770
Mailing Address - Fax:
Practice Address - Street 1:1926 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-1008
Practice Address - Country:US
Practice Address - Phone:559-978-9770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist