Provider Demographics
NPI:1831633684
Name:FAWVER, PATRICIA A (PHD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:FAWVER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 70TH AVE W
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98466-5540
Mailing Address - Country:US
Mailing Address - Phone:253-564-8408
Mailing Address - Fax:
Practice Address - Street 1:2009 70TH AVE W
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98466-5540
Practice Address - Country:US
Practice Address - Phone:253-564-8408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL 60173225101YM0800X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACL 60173225OtherCOUNSELOR CERTIFIED CERTIFICATION
WA601369893OtherUBI