=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144292277
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN W. FABRE M.A., L.P.C., N.C.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 939 GARDENVIEW OFFICE PKWY
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63141-5917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-274-3203
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8040 MEDLEY HILL ACRES RD
-----------------------------------------------------
City | CEDAR HILL
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63016-3413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-274-3203
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 2005025543
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------