Provider Demographics
NPI:1922293323
Name:FATTIG, MARY FAYE (EDS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:FAYE
Last Name:FATTIG
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 N HASTINGS AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-5169
Mailing Address - Country:US
Mailing Address - Phone:308-379-3187
Mailing Address - Fax:
Practice Address - Street 1:422 N HASTINGS AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-5169
Practice Address - Country:US
Practice Address - Phone:308-379-3187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-09
Last Update Date:2007-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2214101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor