Individual
RICHARD WILLIAM FAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, L.P.
Contact information
Practice address
522 BELTRAMI AVE NW STE 17, BEMIDJI, MN 56601-3182
(218) 407-2595
Mailing address
9640 MARCELLA DR NE, BEMIDJI, MN 56601-7030
(218) 586-2876
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP 3436
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
283522300
—
MN
01
—
43B77FA
BCBS OF MN
MN
Enumeration date
09/15/2006
Last updated
02/09/2024
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