Active NPI
William D Fairbanks, PH.D., LPC
- Counselor
- Cheyenne, WY
National Provider Identifier
1114901964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 261
- Practice address
- 2526 Seymour Ave
Cheyenne, WY 82001-3159 - Phone
- (307) 634-9653
- Fax
- (307) 638-8256
- NPI assigned
- Dec 5, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 261 | WY | Primary |
Addresses
Primary practice location
2526 Seymour Ave
Cheyenne, WY 82001-3159
Mailing address
2526 Seymour Ave
Cheyenne, WY 82001-3159
Phone (307) 634-9653
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 311734 | Other | WY | BS OF WY |
| MH60 | Other | WY | WINHEALTH PARTNERS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1300147200000",
"number": "1114901964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2526 SEYMOUR AVE",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820013159",
"telephone_number": "307-634-9653",
"fax_number": "307-638-8256"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2526 SEYMOUR AVE",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820013159",
"telephone_number": "307-634-9653",
"fax_number": "307-638-8256"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAIRBANKS",
"first_name": "WILLIAM",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "PH.D., LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-05",
"last_updated": "2011-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WY",
"license": "261",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BS OF WY",
"identifier": "311734",
"state": "WY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WINHEALTH PARTNERS",
"identifier": "MH60",
"state": "WY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cheyenne, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.