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NPI Code Detail

MEDICARE: KEITH FARAH LICDC

MEDICARE: KEITH FARAH LICDC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor162980OH

General Provider Information

NPI Number : 1184561474
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEITH FARAH LICDC
Provider Business Mailing Address
First Line : 1449 MELLWOOD AVE
Second Line :
City : LOUISVILLE
State : KY
Zip : 40206-1747
Country : US
Telephone Number : 502-207-1990
Fax Number :
Provider Business Practice Location Address
First Line : 4747 MONROE ST
Second Line :
City : TOLEDO
State : OH
Zip : 43623-4307
Country : US
Telephone Number : 502-207-1990
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2026
Last Update Date : 05/04/2026

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Directions to “ KEITH FARAH LICDC” Practice Location

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