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General NPI Number Information
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NPI Number | 1720473945
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Entity Type | Individual
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Provider Name | REVA FABER LPC
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Gender | Female
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Dates
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Enumeration Date | 04/03/2015
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Last Update Date | 04/03/2015
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Provider Practice Location Address
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Address Line | 10702 MANCHESTER RD STE 201
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City | KIRKWOOD
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State | MO
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Zip | 63122-1321
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Country | US
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Telephone | 314-529-1595
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Fax | 775-295-5087
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Provider Business Mailing Address
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Address Line | 10702 MANCHESTER RD STE 201
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City | KIRKWOOD
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State | MO
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Zip | 63122-1321
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Country | US
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Telephone | 314-529-1595
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Fax | 775-295-5087
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2015009705
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License Number State | MO
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