Active NPI
Colleen Marie Fairbanks, PH.D.
- Clinical Psychologist
- Fort Sam Houston, TX
National Provider Identifier
1699914606
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071.007621
- Practice address
- 3551 Roger Brooke Dr
Fort Sam Houston, TX 78234-4504 - Phone
- (726) 228-0441
- NPI assigned
- Feb 13, 2009
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071.007621 | IL | Primary |
Addresses
Primary practice location
3551 Roger Brooke Dr
Fort Sam Houston, TX 78234-4504
Mailing address
3551 Roger Brooke Dr
Fort Sam Houston, TX 78234-4504
Phone (726) 228-0441
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071.007621 | IL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1234483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736294400000",
"number": "1699914606",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3551 ROGER BROOKE DR",
"city": "FORT SAM HOUSTON",
"state": "TX",
"postal_code": "782344504",
"telephone_number": "726-228-0441"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3551 ROGER BROOKE DR",
"city": "FORT SAM HOUSTON",
"state": "TX",
"postal_code": "782344504",
"telephone_number": "726-228-0441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAIRBANKS",
"first_name": "COLLEEN",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-02-13",
"last_updated": "2025-01-08",
"certification_date": "2025-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071.007621",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Sam Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.