Fairbanks Center for Couple and Family Therapy

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

FAIRBANKS CENTER FOR COUPLE AND FAMILY THERAPY

Doing business as

Fairbanks Center for Couple and Family Therapy

Practice address

516 2ND Ave Ste 210
Fairbanks, AK 99701-4738

Phone

(907) 931-9919

Fax

(907) 931-9919

NPI assigned

Apr 21, 2023

Organization subpart

No

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

Authorized official

Name

Regina L Davis

Title

Ceo

Phone

(907) 687-1637

Specialties & licenses 1

Addresses

Other names 1

• Fairbanks Center for Couple and Family Therapy Doing business as

Locations

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

{
    "created_epoch": "1682035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682035200000",
    "number": "1649967365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 2ND AVE STE 210",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014738",
            "telephone_number": "907-931-9919",
            "fax_number": "907-931-9919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 2ND AVE STE 210",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014738",
            "telephone_number": "907-931-9919",
            "fax_number": "907-931-9919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRBANKS CENTER FOR COUPLE AND FAMILY THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-21",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "REGINA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "907-687-1637"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairbanks Center for Couple and Family Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2023; 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.