Provider Demographics
NPI:1164198826
Name:FAIRBANK, SHAINA LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:SHAINA
Middle Name:LYNN
Last Name:FAIRBANK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 181
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-0181
Mailing Address - Country:US
Mailing Address - Phone:406-303-3564
Mailing Address - Fax:406-225-7989
Practice Address - Street 1:2 6TH AVE E
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-2726
Practice Address - Country:US
Practice Address - Phone:406-303-3564
Practice Address - Fax:406-225-7989
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT236361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical