Provider Demographics
NPI:1013226034
Name:FARBER, KELLY ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:FARBER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 N TEJON ST
Mailing Address - Street 2:2ND FLOOR, SUITE #2
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-4926
Mailing Address - Country:US
Mailing Address - Phone:719-482-8483
Mailing Address - Fax:
Practice Address - Street 1:524 N TEJON ST
Practice Address - Street 2:2ND FLOOR, SUITE #2
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-4926
Practice Address - Country:US
Practice Address - Phone:719-482-8483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-26
Last Update Date:2010-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1500101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor