Individual
DR. WALTER WORLEY FAIN III
Active
Individual
DR. WALTER WORLEY FAIN III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.D.
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
P0000001139
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2004080
BLUE CROSS NUMBER
TN
01
—
62-1424098-379200000
CHAMPUS NUMBER
TN
Enumeration date
12/15/2005
Last updated
02/02/2009
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