Active NPI
Jessica Fairfax, LMFT
- Counselor
- Simpsonville, SC
National Provider Identifier
1396264065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 205 Bryce Cir Ste B
Simpsonville, SC 29681-4842 - Phone
- (864) 408-8949
- NPI assigned
- Sep 14, 2017
- Last updated
- Dec 30, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 | SC | Primary |
Addresses
Primary practice location
205 Bryce Cir Ste B
Simpsonville, SC 29681-4842
Mailing address
205 Bryce Cir Ste B
Simpsonville, SC 29681-4842
Phone (864) 408-8949
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 13, 2024 through Jan 13, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7007 | SC | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640822400000",
"number": "1396264065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "205 BRYCE CIR STE B",
"city": "SIMPSONVILLE",
"state": "SC",
"postal_code": "296814842",
"telephone_number": "864-408-8949"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 BRYCE CIR STE B",
"city": "SIMPSONVILLE",
"state": "SC",
"postal_code": "296814842",
"telephone_number": "864-408-8949"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAIRFAX",
"first_name": "JESSICA",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-14",
"last_updated": "2021-12-30",
"certification_date": "2021-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "SC",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Simpsonville, SC
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- Excalibur Youth Services, LLC.
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- Fairview Family Practice
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- Family Dental Health of Fairview LLC
- Family Dental Health of Five Forks LLC
- Family Restoration Counseling Services, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.