Organization
ROBERT FANE AGENCY, LLCP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT BRUCE FANE ED.D (OWNER)
(270) 393-9833
Entity
Organization
Contact information
Practice address
1011 LEHMAN AVE, SUITE 103, BOWLING GREEN, KY 42103-6515
(270) 393-9833
(270) 393-9835
Mailing address
1011 LEHMAN AVE, SUITE 103, BOWLING GREEN, KY 42103-6515
(270) 393-9833
(270) 393-9835
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
1104
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
29100914
—
KY
05
—
29200912
—
KY
Enumeration date
03/25/2008
Last updated
10/21/2014
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