| Fairbank Counseling, Pllc | |
|
2 6th Ave E Polson MT 59860-2726 | |
| (406) 214-3137 | |
| Not Available |
| Full Name | Fairbank Counseling, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 2 6th Ave E, Polson, Montana |
| Authorized Official Name and Position | Coyote Fairbank (OWNER) |
| Authorized Official Contact | 4062143137 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fairbank Counseling, Pllc Po Box 181 Polson MT 59860-0181 Ph: (406) 214-3137 | Fairbank Counseling, Pllc 2 6th Ave E Polson MT 59860-2726 Ph: (406) 214-3137 |
| NPI Number | 1396410130 |
|---|---|
| Provider Enumeration Date | 08/13/2021 |
| Last Update Date | 08/13/2021 |
| Certification Date | 08/13/2021 |
| Medicare PECOS PAC ID | 0446642011 |
|---|---|
| Medicare Enrollment ID | O20220112001433 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396410130 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Coyote Kyle Wayne Fairbank |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447783170 PECOS PAC ID: 4183901531 Enrollment ID: I20170511002801 |
| Provider Name | Shaina Lynn Fairbank |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164198826 PECOS PAC ID: 8426444217 Enrollment ID: I20220404001538 |
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