Provider Demographics
NPI:1104985365
Name:PHAIR, HEIDI LORENE (MA)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:LORENE
Last Name:PHAIR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 JAHN AVE. NW SUITE C4
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335
Mailing Address - Country:US
Mailing Address - Phone:253-514-2367
Mailing Address - Fax:253-851-6199
Practice Address - Street 1:2703 JAHN AVE. NW SUITE C4
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335
Practice Address - Country:US
Practice Address - Phone:253-514-2367
Practice Address - Fax:253-851-6199
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA020705LF00000802106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist