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General NPI Number Information
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NPI Number | 1679437453
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Entity Type | Organization
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Legal Business Name | FAIRCLOUGH CONSULTING SERVICES, LLC
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 1300 S JONES BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89146-1205
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Country | US
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Telephone | 561-309-3507
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Fax | 702-975-1022
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Provider Business Mailing Address
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Address Line | 9224 TUDOR PARK PL
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City | LAS VEGAS
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State | NV
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Zip | 89145-8726
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Country | US
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Telephone | 561-309-3507
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Fax | 702-975-1022
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Authorized Official
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Title or Position | CEO/COUNSELOR
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Name | DR. KEITH ANTHONY FAIRCLOUGH JR.
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Credential | EDD, CPC, LMHC, ACS
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Telephone | 561-309-3507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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