Provider Demographics
NPI:1174915151
Name:FAHEY, GAIL (MD)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:FAHEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E FOURTH PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3713
Mailing Address - Country:US
Mailing Address - Phone:360-696-4061
Mailing Address - Fax:
Practice Address - Street 1:1601 E FOURTH PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3713
Practice Address - Country:US
Practice Address - Phone:360-696-4061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-27
Last Update Date:2017-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA33780981103TB0200X
WA4054878253J00000X
WA4028798251B00000X
WA60167155385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No253J00000XAgenciesFoster Care Agency
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA680-709OtherICD-9CM
WACIMCOtherINTERNAL MEDICINE
WAP100, P300OtherSTRUCTURE, STRATEGY, ANALYSIS
WA390-459OtherICD-9CM
WAC100, C200, C300OtherCOUNSELING
WAC400OtherCOUNSELING
WACEMCOtherEVALUATION AND MANAGEMENT
WACFPCOtherFAMILY PRACTICE
WAT1015OtherCLINIC SERVICE
WA740-759OtherICD-9CM
WACHONCOtherHEMATOLOGY AND ONCOLOGY
WAL100, L300, A100OtherCASE ASSESSMENT, DEVELOPMENT, AND ADMINISTRATION
WA1174915151OtherPATHOLOGY
WA140-239OtherICD-9-CM
WACEDCOtherEMERGENCY DEPARTMENT