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General NPI Number Information
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NPI Number | 1790194140
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Entity Type | Individual
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Provider Name | CAITLIN D FAHRNER LPC
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Gender | Female
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Dates
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Enumeration Date | 08/11/2014
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Last Update Date | 07/23/2018
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Provider Practice Location Address
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Address Line | 11042 MANCHESTER RD
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City | KIRKWOOD
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State | MO
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Zip | 63122
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Country | US
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Telephone | 844-462-3492
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Fax |
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Provider Business Mailing Address
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Address Line | 7022 MARQUETTE AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63139-2107
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Country | US
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Telephone | 618-973-3231
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Fax |
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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 | 2013007076
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License Number State | MO
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