# ROBERT FANE AGENCY, LLCP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639341126
- **Authorized official:** ROBERT BRUCE FANE ED.D (OWNER)
- **Authorized official phone:** (270) 393-9833

## Contact information

- **Practice address:** 1011 LEHMAN AVE, SUITE 103, BOWLING GREEN, KY 42103-6515
- **Practice address phone:** (270) 393-9833
- **Practice address fax:** (270) 393-9835
- **Mailing address:** 1011 LEHMAN AVE, SUITE 103, BOWLING GREEN, KY 42103-6515
- **Mailing address phone:** (270) 393-9833
- **Mailing address fax:** (270) 393-9835

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | 1104 | KY | Yes |

## Other

- **Enumeration date:** 03/25/2008
- **Last updated:** 10/21/2014