Healthcare Provider Details

I. General information

NPI: 1669098745
Provider Name (Legal Business Name): CHRISTIAN MARY ELIZABETH FAIR MS, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTIAN MARY ELIZABETH GOBIN

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2904 FOLTZ DR
EDGEWOOD KY
41017-2525
US

IV. Provider business mailing address

PO BOX 737441
CHICAGO IL
60673-7441
US

V. Phone/Fax

Practice location:
  • Phone: 859-795-3000
  • Fax: 317-520-8200
Mailing address:
  • Phone: 855-324-0885
  • Fax: 317-520-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number312166
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: