Provider Demographics
NPI:1811971948
Name:FAIRBANKS COUNSELING AND ADOPTION
Entity type:Organization
Organization Name:FAIRBANKS COUNSELING AND ADOPTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNELLY TERHUNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-456-4729
Mailing Address - Street 1:PO BOX 71544
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-1544
Mailing Address - Country:US
Mailing Address - Phone:907-456-4729
Mailing Address - Fax:907-456-4623
Practice Address - Street 1:912 BARNETTE ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4510
Practice Address - Country:US
Practice Address - Phone:907-456-4729
Practice Address - Fax:907-456-4623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK153291Medicare PIN