MEDICARE: MRS. CHLOE LESLIE FAHRBERGER MS, BCBA

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	103K00000X	Behavior Analyst	1-17-26585	CO

General Provider Information

NPI Number	:	1629590914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHLOE LESLIE FAHRBERGER MS, BCBA

Provider Business Mailing Address
First Line	:	PO BOX 258831
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73125-8831
Country	:	US
Telephone Number	:	720-697-3649
Fax Number	:

Provider Business Practice Location Address
First Line	:	11225 N 28TH DR STE C202
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-5600
Country	:	US
Telephone Number	:	720-697-3649
Fax Number	:

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

Provider Enumeration Date	:	07/09/2017
Last Update Date	:	03/03/2026

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