Provider Demographics
NPI:1932636305
Name:FAHEY, DEVON (CSW)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:FAHEY
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:DEVON
Other - Middle Name:
Other - Last Name:TURLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:720 W BROADWAY STE 202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3245
Mailing Address - Country:US
Mailing Address - Phone:502-561-0943
Mailing Address - Fax:502-561-0944
Practice Address - Street 1:645 S ROY WILKINS AVE STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2072
Practice Address - Country:US
Practice Address - Phone:502-583-4092
Practice Address - Fax:502-371-6110
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7520405300000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No405300000XOther Service ProvidersPrevention Professional