Provider Demographics
NPI:1609599638
Name:FAIRLEY-HAYES, JONOBRIA (LPCA)
Entity Type:Individual
Prefix:
First Name:JONOBRIA
Middle Name:
Last Name:FAIRLEY-HAYES
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15383 S GRAVES RD
Mailing Address - Street 2:
Mailing Address - City:MULINO
Mailing Address - State:OR
Mailing Address - Zip Code:97042-9789
Mailing Address - Country:US
Mailing Address - Phone:503-860-1566
Mailing Address - Fax:360-210-1350
Practice Address - Street 1:15383 S GRAVES RD
Practice Address - Street 2:
Practice Address - City:MULINO
Practice Address - State:OR
Practice Address - Zip Code:97042-9789
Practice Address - Country:US
Practice Address - Phone:503-860-1566
Practice Address - Fax:360-210-1350
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health