Provider Demographics
NPI:1295600989
Name:ABEL, FAYTH NIKOLE
Entity type:Individual
Prefix:
First Name:FAYTH
Middle Name:NIKOLE
Last Name:ABEL
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 1:613 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:OLD MONROE
Mailing Address - State:MO
Mailing Address - Zip Code:63369-2650
Mailing Address - Country:US
Mailing Address - Phone:636-626-1102
Mailing Address - Fax:636-626-1102
Practice Address - Street 1:613 ASPEN DR
Practice Address - Street 2:
Practice Address - City:OLD MONROE
Practice Address - State:MO
Practice Address - Zip Code:63369-2650
Practice Address - Country:US
Practice Address - Phone:636-626-1102
Practice Address - Fax:636-626-1102
Is Sole Proprietor?:No
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORBT-23-275697106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician