Christina Lynne Dalke Fairbanks, PH.D., M.S.

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

2013040131 Issued in MO

Practice address

13000 Bruce B Downs Blvd
Tampa, FL 33612

Phone

(813) 631-2525

Fax

(813) 631-7128

NPI assigned

Dec 11, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Christina L Khan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1355184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643068800000",
    "number": "1750626164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13000 BRUCE B DOWNS BLVD (116A)",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336124745",
            "telephone_number": "813-631-2525",
            "fax_number": "813-631-7128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13000 BRUCE B DOWNS BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33612",
            "telephone_number": "813-631-2525",
            "fax_number": "813-631-7128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRBANKS",
        "first_name": "CHRISTINA",
        "middle_name": "LYNNE DALKE",
        "name_prefix": "Dr.",
        "credential": "PH.D., M.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-12-11",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "KS",
            "license": "T-LMLP 2424",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MO",
            "license": "2013040131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTINA",
            "last_name": "KHAN",
            "middle_name": "L",
            "prefix": "DR.",
            "credential": "PH.D., M.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Henria M Fain, M.D., DPT, ATC
• Fair Health Care LLC
• Rodneisha Fair
• Taylor Fair, MSN, APRN, FNP-C
• Garrett Fairbairn
• Courtney Ridley Fairbanks, AUD
• David Edward Fairleigh, M.D.
• Fairway Oaks Center, LLC
• Sunshine Faison, ARNP
• Faith Home Health, Inc

• Counseling Psychologist in Tampa, FL
• Providers in Tampa, FL by specialty
• Counseling Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2022; 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.