Provider Demographics
NPI:1619395001
Name:FAAS, AVERY HARRIS
Entity Type:Individual
Prefix:MS
First Name:AVERY
Middle Name:HARRIS
Last Name:FAAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 GREEN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-8737
Mailing Address - Country:US
Mailing Address - Phone:937-231-9282
Mailing Address - Fax:
Practice Address - Street 1:1209 HILL RD N
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-8888
Practice Address - Country:US
Practice Address - Phone:740-739-3693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst