Provider Demographics
NPI:1699042085
Name:FAIRBANKS, DENISE STARR
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:STARR
Last Name:FAIRBANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6432 N PENIEL AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-7219
Mailing Address - Country:US
Mailing Address - Phone:602-578-8645
Mailing Address - Fax:
Practice Address - Street 1:6432 N PENIEL AVE APT 62
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-7219
Practice Address - Country:US
Practice Address - Phone:602-578-8645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst