Mary Ann Fahlstrom, MFT 47696

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

T0724 Issued in OR

Practice address

189 Liberty St NE
Suite 202
Salem, OR 97301-3682

Phone

(503) 409-5086

NPI assigned

Nov 9, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Mary Ann Fahlstrom Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Empowerment & Transformation, Inc.

  • Marriage & Family Therapist
  • Salem, OR
  • NPI 1326597808
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435622400000",
    "number": "1649340084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "189 LIBERTY ST NE",
            "address_2": "SUITE 202",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013682",
            "telephone_number": "503-409-5086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "189 LIBERTY ST NE",
            "address_2": "SUITE 202",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013682",
            "telephone_number": "503-409-5086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAHLSTROM",
        "first_name": "MARY",
        "middle_name": "ANN",
        "credential": "MFT 47696",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-09",
        "last_updated": "2015-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "OR",
            "license": "T0724",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "47696",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "FAHLSTROM",
            "middle_name": "ANN",
            "credential": "LMFT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amy Fagin
• Susan Mary Fagin, MENTAL HEALTH COUNSE
• Wayne Fagin, LMT
• Urooba Faheem, M.D
• Karie Diana Fahey, MSW, LCSW
• Kelly Ann Fair, M.D.
• Gerald David Fairbanks, RPH
• Reid Faith, PHD
• Alejandra Fajardo
• Mary Y Fajer, PT OCS

• Marriage & Family Therapist in Salem, OR
• Providers in Salem, OR by specialty
• Marriage & Family Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.