Healthcare Provider Details

I. General information

NPI: 1932636305
Provider Name (Legal Business Name): DEVON FAHEY CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEVON TURLEY CSW

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 S ROY WILKINS AVE STE 100
LOUISVILLE KY
40203-2072
US

IV. Provider business mailing address

2020 NEWBURG RD
LOUISVILLE KY
40205-1803
US

V. Phone/Fax

Practice location:
  • Phone: 502-583-4092
  • Fax: 502-371-6110
Mailing address:
  • Phone: 502-601-7085
  • Fax: 502-479-4259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number7520
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7520
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number257865
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: