Provider Demographics
NPI:1154662096
Name:KEBE, FATOU
Entity Type:Individual
Prefix:
First Name:FATOU
Middle Name:
Last Name:KEBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 MEADOWOOD MALL CIR APT 244
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-6639
Mailing Address - Country:US
Mailing Address - Phone:775-247-5659
Mailing Address - Fax:
Practice Address - Street 1:2470 WRONDEL WAY # 275
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3701
Practice Address - Country:US
Practice Address - Phone:775-336-2812
Practice Address - Fax:775-336-1082
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health