Provider Demographics
NPI:1003287913
Name:FBX FAIRBANKS BEHAVIOR
Entity Type:Organization
Organization Name:FBX FAIRBANKS BEHAVIOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TANORI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:907-378-3434
Mailing Address - Street 1:PO BOX 80448
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-0448
Mailing Address - Country:US
Mailing Address - Phone:907-378-3434
Mailing Address - Fax:907-374-0820
Practice Address - Street 1:3245 CRAFT AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5772
Practice Address - Country:US
Practice Address - Phone:907-378-3434
Practice Address - Fax:907-374-0820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty