Provider Demographics
NPI:1720605959
Name:FAYDON LLC
Entity Type:Organization
Organization Name:FAYDON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HATTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:314-374-1543
Mailing Address - Street 1:2603 W BAINBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-5908
Mailing Address - Country:US
Mailing Address - Phone:314-374-1543
Mailing Address - Fax:
Practice Address - Street 1:5304 ALMEDA RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7440
Practice Address - Country:US
Practice Address - Phone:314-374-1543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX77890OtherTEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS