Jennifer Fairbourn, MS, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

7007405-3902 Issued in UT

Practice address

7321 S State St
Suite a
Midvale, UT 84047-2055

Phone

(801) 878-4327

Fax

(801) 878-9280

NPI assigned

Mar 26, 2008

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

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Marriage and Family Therapist

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jennifer Fairbourn LMFT LLCGroup PAC ID 5294116455, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

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.

• Jennifer Fairbourn LMFT, LLC

  • Mental Health Counselor
  • Midvale, UT
  • NPI 1356826036
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1206489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454976000000",
    "number": "1992977383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7321 S STATE ST",
            "address_2": "SUITE A",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840472055",
            "telephone_number": "801-878-4327",
            "fax_number": "801-878-9280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7321 S STATE ST",
            "address_2": "SUITE A",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840472055",
            "telephone_number": "801-878-4327",
            "fax_number": "801-878-9280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRBOURN",
        "first_name": "JENNIFER",
        "name_prefix": "Ms.",
        "credential": "MS, LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-26",
        "last_updated": "2016-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "UT",
            "license": "7007405-3902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evergreen Place LLC
• Eye Care for Kids
• Eye Prosthetics of Utah, Inc.
• Margaret Nasareta Faauli
• Lillian Nicole Fackrell, DC
• Joshua Stephen Falk, LCSW
• Lynn Don Falkner, PA
• Family Support Center
• Family Support Center
• Farrington Health Care LLC

• Marriage & Family Therapist in Midvale, UT
• Providers in Midvale, UT by specialty
• Marriage & Family Therapist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2016; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.