Provider Demographics
NPI:1679906440
Name:FAY, MIRIAM SOLER (EDD, MED)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:SOLER
Last Name:FAY
Suffix:
Gender:F
Credentials:EDD, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 MORGAN CT
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-1588
Mailing Address - Country:US
Mailing Address - Phone:417-437-1670
Mailing Address - Fax:417-359-8094
Practice Address - Street 1:311 MORGAN CT
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-1588
Practice Address - Country:US
Practice Address - Phone:417-437-1670
Practice Address - Fax:417-359-8094
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012030160101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health