Provider Demographics
NPI:1982045613
Name:FAIRBANK, MICHELLE D (LCPC-S, LMAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:FAIRBANK
Suffix:
Gender:F
Credentials:LCPC-S, LMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 HALL ST STE 13
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1964
Mailing Address - Country:US
Mailing Address - Phone:785-261-0694
Mailing Address - Fax:785-261-0697
Practice Address - Street 1:2703 HALL ST STE 13
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-1964
Practice Address - Country:US
Practice Address - Phone:785-261-0694
Practice Address - Fax:785-261-0697
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2486101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty