Provider Demographics
NPI:1558393249
Name:WEST, KELI FAUBER (PSYD)
Entity Type:Individual
Prefix:
First Name:KELI
Middle Name:FAUBER
Last Name:WEST
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:FT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2609
Mailing Address - Country:US
Mailing Address - Phone:859-426-0900
Mailing Address - Fax:859-426-0999
Practice Address - Street 1:2045 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41011-2609
Practice Address - Country:US
Practice Address - Phone:859-426-0900
Practice Address - Fax:859-426-0999
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2005-81103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCP00222Medicare PIN