Healthcare Provider Details

I. General information

NPI: 1457338717
Provider Name (Legal Business Name): RAYMOND L. FABING PHD, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 E MAIN ST
PARK HILLS MO
63601-2634
US

IV. Provider business mailing address

PO BOX 506
PARK HILLS MO
63601-0506
US

V. Phone/Fax

Practice location:
  • Phone: 573-431-3341
  • Fax: 573-431-5205
Mailing address:
  • Phone: 573-431-0554
  • Fax: 573-431-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMO-CS001016
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: