Healthcare Provider Details

I. General information

NPI: 1558393249
Provider Name (Legal Business Name): KELI FAUBER WEST PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 DIXIE HWY
FT MITCHELL KY
41011-2609
US

IV. Provider business mailing address

2045 DIXIE HWY
FT MITCHELL KY
41011-2609
US

V. Phone/Fax

Practice location:
  • Phone: 859-426-0900
  • Fax: 859-426-0999
Mailing address:
  • Phone: 859-426-0900
  • Fax: 859-426-0999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2005-81
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: