Individual ProviderKeith Anthony FaircloughCounselorBehavioral Health & Social Service ProvidersPractice Address1300 S Jones Blvd Ste 250, Las Vegas, NV 89146-1210(561) 309-3507PECOS EnrollmentBased on the most recent information from CMS, provider Keith Anthony Fairclough does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1831563097Provider TypeIndividualFull NameFairclough, Keith AnthonyTitleDr.CredentialLMHC, CPC, ACSGenderMaleSole ProprietorYesEnumeration Date11/25/2015Last Updated1/27/2026Contact InformationPractice LocationPractice Address1300 S Jones Blvd Ste 250, Las Vegas, NV 89146-1210Phone(561) 309-3507Fax(702) 975-1022Mailing LocationMailing Address9224 Tudor Park Pl, Las Vegas, NV 89145-8726Phone(561) 309-3507Fax(702) 975-1022Provider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseCP3002-RNevadaCode101YM0800XDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseMH15958Florida