Organization
FAIRCLOUGH CONSULTING SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEITH ANTHONY FAIRCLOUGH JR. LMHC (CEO)
(561) 309-3507
Entity
Organization
Contact information
Practice address
9224 TUDOR PARK PL, LAS VEGAS, NV 89145-8726
(561) 309-3507
Mailing address
9224 TUDOR PARK PL, LAS VEGAS, NV 89145-8726
(561) 309-3507
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831563097
—
FL
Enumeration date
07/17/2020
Last updated
07/17/2020
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