Provider Demographics
NPI:1891119244
Name:DISNEY-FAIRCHILD, KATHERINE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:DISNEY-FAIRCHILD
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 1:2821 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE 121
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4427
Mailing Address - Country:US
Mailing Address - Phone:702-265-7245
Mailing Address - Fax:
Practice Address - Street 1:2821 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 121
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4427
Practice Address - Country:US
Practice Address - Phone:702-265-7245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01427106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist