Nicole Fairchild, LPC
Individual provider Active NPI School Counselor · Jasper, AR
NPI 1104824341 · NPPES record last updated Apr 2, 2015
Key facts
- NPI
- 1104824341
- Entity type
- Individual (NPI type 1)
- Primary specialty
- School Counselor 101YS0200X
- License
- P1011074 (AR)
- Practice address
- 600 School St
Jasper School District
Jasper, AR 72641-8802 - Phone
- (870) 446-9305
- Fax
- (870) 446-6754
- NPI assigned
- Jul 12, 2005
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2002031917 | MO | MD | Professional Counselor |
| P1011074 | AR | MD | School Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2002031917 | MO | |
| School Counselor | 101YS0200X | P1011074 | AR | Yes |
Addresses
Primary practice location
600 School St
Jasper School District
Jasper, AR 72641-8802
Mailing address
600 School St
Jasper School District
Jasper, AR 72641-8802
Phone (870) 446-9305
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 497205401 | Medicaid | MO |
Other providers in Jasper, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 2, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.