Provider Demographics
NPI:1780690909
Name:FAIR, STEVEN RICHARD (LMSW)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:RICHARD
Last Name:FAIR
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NB GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2301
Mailing Address - Country:US
Mailing Address - Phone:586-783-2950
Mailing Address - Fax:586-690-4333
Practice Address - Street 1:100 NB GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043
Practice Address - Country:US
Practice Address - Phone:586-783-2950
Practice Address - Fax:586-690-4333
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010692381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI139863SWOtherCARE CHOICES HMO
MI235213000OtherMAGELLAN HEALTH SERVICES
MI9817558OtherCIGNA BEHAVIORAL HEALTH
MI0892947OtherBLUE CROSS BLUE SHIELD MI
MI149663OtherVALUE OPTIONS
MISF069238OtherBLUE CROSS BLUE SHIELD MI