MEDICARE: KELLY ANN FARBER L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	1500	CO

General Provider Information

NPI Number	:	1013226034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ANN FARBER L.C.S.W.

Provider Business Mailing Address
First Line	:	524 N TEJON ST
Second Line	:	2ND FLOOR, SUITE #2
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-4926
Country	:	US
Telephone Number	:	719-482-8483
Fax Number	:

Provider Business Practice Location Address
First Line	:	524 N TEJON ST
Second Line	:	2ND FLOOR, SUITE #2
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-4926
Country	:	US
Telephone Number	:	719-482-8483
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2010
Last Update Date	:	09/26/2010

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