Provider Demographics
NPI:1679115794
Name:SALIX, FEN (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:FEN
Middle Name:
Last Name:SALIX
Suffix:
Gender:X
Credentials:PHD, LP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:MELIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2305 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-3653
Mailing Address - Country:US
Mailing Address - Phone:301-395-0647
Mailing Address - Fax:
Practice Address - Street 1:120 N BEAVER ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-5573
Practice Address - Country:US
Practice Address - Phone:162-369-5798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY005888103T00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program