Provider Demographics
NPI:1760681795
Name:FABER, JOAN RUTH (MFT)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:RUTH
Last Name:FABER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:FANSHEN
Other - Middle Name:JOAN
Other - Last Name:FABER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:CA
Mailing Address - Zip Code:95410
Mailing Address - Country:US
Mailing Address - Phone:707-937-2791
Mailing Address - Fax:707-937-2791
Practice Address - Street 1:10520 HOWARD STREET
Practice Address - Street 2:
Practice Address - City:MENDOCINO
Practice Address - State:CA
Practice Address - Zip Code:95460
Practice Address - Country:US
Practice Address - Phone:707-937-2791
Practice Address - Fax:707-937-2791
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT34097106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist