Healthcare Provider Details

I. General information

NPI: 1679437453
Provider Name (Legal Business Name): FAIRCLOUGH CONSULTING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S JONES BLVD
LAS VEGAS NV
89146-1205
US

IV. Provider business mailing address

9224 TUDOR PARK PL
LAS VEGAS NV
89145-8726
US

V. Phone/Fax

Practice location:
  • Phone: 561-309-3507
  • Fax: 702-975-1022
Mailing address:
  • Phone: 561-309-3507
  • Fax: 702-975-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. KEITH ANTHONY FAIRCLOUGH JR.
Title or Position: CEO/COUNSELOR
Credential: EDD, CPC, LMHC, ACS
Phone: 561-309-3507