Fairbank Counseling, PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

FAIRBANK COUNSELING, PLLC

Practice address

2 6TH Ave E
Polson, MT 59860-2726

Phone

(406) 214-3137

NPI assigned

Aug 13, 2021

Organization subpart

No

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

Authorized official

Name

Coyote Fairbank, LCSW

Title

Owner

Phone

(406) 214-3137

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1628812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628812800000",
    "number": "1396410130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 181",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "598600181",
            "telephone_number": "406-214-3137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 6TH AVE E",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "598602726",
            "telephone_number": "406-214-3137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRBANK COUNSELING, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-13",
        "last_updated": "2021-08-13",
        "certification_date": "2021-08-13",
        "status": "A",
        "authorized_official_last_name": "FAIRBANK",
        "authorized_official_first_name": "COYOTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "406-214-3137",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Marie Elliott, OTRL
• Jamie Michael Engeldrum, PA-C
• Donald Paul Ericksen, M.D.
• David Jason Erickson I, L.M.T
• Evergreen at Polson, L.L.C. (Polson Health and Rehabilitation Center)
• Coyote Fairbank, LCSW
• Shaina Lynn Fairbank, LCSW
• Sandra Fisher, PHARM. D.
• Travis Ladel Fisher, RDH
• Michael J Flannery, MD

• Clinical Social Worker in Polson, MT
• Providers in Polson, MT by specialty
• Clinical Social Worker in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2021; 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.