MEDICARE: KELI FAUBER WEST PSYD

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	103T00000X	Psychologist	2005-81	KY

General Provider Information

NPI Number	:	1558393249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELI FAUBER WEST PSYD

Provider Business Mailing Address
First Line	:	2045 DIXIE HWY
Second Line	:
City	:	FT MITCHELL
State	:	KY
Zip	:	41011-2609
Country	:	US
Telephone Number	:	859-426-0900
Fax Number	:	859-426-0999

Provider Business Practice Location Address
First Line	:	2045 DIXIE HWY
Second Line	:
City	:	FT MITCHELL
State	:	KY
Zip	:	41011-2609
Country	:	US
Telephone Number	:	859-426-0900
Fax Number	:	859-426-0999

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	06/25/2015

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Directions to “ KELI FAUBER WEST PSYD” Practice Location

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