Jessica L Fairbanks

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6401018556 Issued in MI

Practice address

2929 Covington CT
Lansing, MI 48912-4941

Phone

(810) 513-4976

NPI assigned

Aug 18, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Balanced Restoration Services, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Brighton, MI
  • NPI 1801404272
  NPD (past)

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

{
    "created_epoch": "1597708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618876800000",
    "number": "1871105247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4624 DUNMORROW DR",
            "city": "OKEMOS",
            "state": "MI",
            "postal_code": "488641251",
            "telephone_number": "517-881-2587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2929 COVINGTON CT",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489124941",
            "telephone_number": "810-513-4976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRBANKS",
        "first_name": "JESSICA",
        "middle_name": "L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-18",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401018556",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6401018556",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Igiraneza Fabiola
• Farah Fadel, PHARM.D
• Suzanne Fadly, PHARM D.
• Fereshteh Fahimi, MD
• Colleen Threse Fahrenbach, DDS
• Megan Elizabeth Fairchild, RBT
• Ann Al Maha Faisal, MD
• Faith Health Systems
• Family Services LLC
• Family Therapy Connections

• All providers in Lansing, MI
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 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.