Provider Demographics
NPI:1669098745
Name:FAIR, CHRISTIAN MARY ELIZABETH
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:MARY ELIZABETH
Last Name:FAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:MARY ELIZABETH
Other - Last Name:GOBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6502 ELBROOK AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-4349
Mailing Address - Country:US
Mailing Address - Phone:513-401-8953
Mailing Address - Fax:
Practice Address - Street 1:6502 ELBROOK AVE APT 3
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-4349
Practice Address - Country:US
Practice Address - Phone:513-401-8953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRBT-19-91669106S00000X
1-12-67539103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician