Provider Demographics
NPI:1164955472
Name:FAIRBANKS, GABRIELLE (LMFT, MHP, RHT)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:FAIRBANKS
Suffix:
Gender:F
Credentials:LMFT, MHP, RHT
Other - Prefix:
Other - First Name:ELLIE
Other - Middle Name:
Other - Last Name:FAIRBANKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2019 PONDEROSA CT
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-5367
Mailing Address - Country:US
Mailing Address - Phone:425-276-1575
Mailing Address - Fax:
Practice Address - Street 1:2019 PONDEROSA CT
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-5367
Practice Address - Country:US
Practice Address - Phone:425-276-1575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61106391106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist