Provider Demographics
NPI:1457065948
Name:FAYLE, FAY ANN
Entity Type:Individual
Prefix:
First Name:FAY
Middle Name:ANN
Last Name:FAYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FAY
Other - Middle Name:ANN
Other - Last Name:PLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13805 W STELLA LN
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4051
Mailing Address - Country:US
Mailing Address - Phone:208-419-2716
Mailing Address - Fax:
Practice Address - Street 1:3710 W GREENWAY RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-3705
Practice Address - Country:US
Practice Address - Phone:602-466-2036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRBT-22-240421106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician