Provider Demographics
NPI:1255342739
Name:SAWATZKY, FAYNE ALAN (BHRS, CM-A)
Entity type:Individual
Prefix:
First Name:FAYNE
Middle Name:ALAN
Last Name:SAWATZKY
Suffix:
Gender:M
Credentials:BHRS, CM-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 SHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-5442
Mailing Address - Country:US
Mailing Address - Phone:580-323-1773
Mailing Address - Fax:
Practice Address - Street 1:3080 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-4323
Practice Address - Country:US
Practice Address - Phone:580-225-5136
Practice Address - Fax:580-225-5138
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor