Kristen N Fajack, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

245187 Issued in KY

Practice address

1169 Eastern Pkwy Ste 3364
Louisville, KY 40217-1415

Phone

(502) 813-8280

Fax

(502) 473-1334

NPI assigned

Oct 31, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kristen N Gratz Former name

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Peaceful Solutions Counseling Inc

  • Clinical Social Worker
  • Louisville, KY
  • NPI 1770900631
  Medicare reassignment NPD
• New Beginnings Family Services, Inc.

  • Mental Health Counselor
  • Louisville, KY
  • NPI 1215242631
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1540944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620864000000",
    "number": "1962979682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10100 ELIDA RD",
            "city": "DELPHOS",
            "state": "OH",
            "postal_code": "458339058",
            "telephone_number": "419-695-8010",
            "fax_number": "419-695-0004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1169 EASTERN PKWY STE 3364",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402171415",
            "telephone_number": "502-813-8280",
            "fax_number": "502-473-1334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAJACK",
        "first_name": "KRISTEN",
        "middle_name": "N",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-31",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "KY",
            "license": "245187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "GRATZ",
            "middle_name": "N",
            "credential": "LMFT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tarek Faid, CSA
• Margaret Mary De Luna Faile
• Trevor Becht Fain, MD
• Barbara Lovejoy Fairleigh, PT
• Faith in Counseling, LLC
• Anne C Fajardo
• Peyton Fakharpour, PHARMACIST
• Nasir Hussain Fakhri, M.D.
• Omolara O Fakunle, M.D.
• Dawn L Falco, M.D.

• Marriage & Family Therapist in Louisville, KY
• Providers in Louisville, KY by specialty
• Marriage & Family Therapist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.