Provider Demographics
NPI:1710470448
Name:FAY, KEVIN (LMFT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:FAY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 ELATI ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-2707
Mailing Address - Country:US
Mailing Address - Phone:720-441-6658
Mailing Address - Fax:
Practice Address - Street 1:1323 ELATI ST UNIT 4
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-2707
Practice Address - Country:US
Practice Address - Phone:720-441-6658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0001513106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist