Provider Demographics
NPI:1437582947
Name:FASUGBA, KAILEY TERESA (LMHC)
Entity Type:Individual
Prefix:MS
First Name:KAILEY
Middle Name:TERESA
Last Name:FASUGBA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:KAILEY
Other - Middle Name:TERESA
Other - Last Name:KEISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:73 PRINCETON ST STE 212
Mailing Address - Street 2:
Mailing Address - City:N CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-1681
Mailing Address - Country:US
Mailing Address - Phone:978-710-7569
Mailing Address - Fax:
Practice Address - Street 1:73 PRINCETON ST STE 212
Practice Address - Street 2:
Practice Address - City:N CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-1681
Practice Address - Country:US
Practice Address - Phone:978-710-7569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health