Provider Demographics
NPI:1932755824
Name:SIMPSON, FAYE VICTORIA (CB)
Entity Type:Individual
Prefix:
First Name:FAYE
Middle Name:VICTORIA
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:CB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9711 CRESCENT VALLEY DR NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-7555
Mailing Address - Country:US
Mailing Address - Phone:817-454-2841
Mailing Address - Fax:
Practice Address - Street 1:13765 VINTAGE DR SW
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-7391
Practice Address - Country:US
Practice Address - Phone:253-970-2414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA61370580103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WABA61370580OtherSTATE LICENSE