Individual
MARY ANN FAHLSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MFT 47696
Contact information
Practice address
189 LIBERTY ST NE, SUITE 202, SALEM, OR 97301-3682
(503) 409-5086
Mailing address
189 LIBERTY ST NE, SUITE 202, SALEM, OR 97301-3682
(503) 409-5086
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
47696
CA
106H00000X
Marriage & Family Therapist
Primary
T0724
OR
Other
Enumeration date
11/09/2006
Last updated
06/30/2015
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