Fairbanks Somatic Therapy and Wellness LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

FAIRBANKS SOMATIC THERAPY AND WELLNESS LLC

Practice address

250 Cushman St Ste 4E
Fairbanks, AK 99701-4665

Phone

(907) 371-5359

NPI assigned

Nov 8, 2024

Last updated

Nov 8, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brighton Brooks, LPCNPI 1518697879

Title

Manager and Member

Phone

(907) 687-4194

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brighton Brooks

  • Professional Counselor
  • Fairbanks, AK
  • NPI 1518697879
  NPD Authorized official

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

{
    "created_epoch": "1731024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731024000000",
    "number": "1003630872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 YUNANA CT",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997011426",
            "telephone_number": "907-687-4194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 CUSHMAN ST STE 4E",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014665",
            "telephone_number": "907-371-5359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRBANKS SOMATIC THERAPY AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-08",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-08",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "BRIGHTON",
        "authorized_official_title_or_position": "MANAGER AND MEMBER",
        "authorized_official_telephone_number": "907-687-4194",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Professional Counselor in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.