Provider Demographics
NPI:1649967365
Name:FAIRBANKS CENTER FOR COUPLE AND FAMILY THERAPY
Entity type:Organization
Organization Name:FAIRBANKS CENTER FOR COUPLE AND FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-687-1637
Mailing Address - Street 1:516 2ND AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4738
Mailing Address - Country:US
Mailing Address - Phone:907-931-9919
Mailing Address - Fax:907-931-9919
Practice Address - Street 1:516 2ND AVE STE 210
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4738
Practice Address - Country:US
Practice Address - Phone:907-931-9919
Practice Address - Fax:907-931-9919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty