Provider Demographics
NPI:1952516338
Name:FAIRCHILD COUNSELING LLC
Entity Type:Organization
Organization Name:FAIRCHILD COUNSELING LLC
Other - Org Name:CONNIE M FAIRCHILD MA LPC CAC I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT SINGLE ENTITY LLC
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FAIRCHILD
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC CAC I
Authorized Official - Phone:719-291-5623
Mailing Address - Street 1:PO BOX 2687
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901-2687
Mailing Address - Country:US
Mailing Address - Phone:719-291-5623
Mailing Address - Fax:719-473-4066
Practice Address - Street 1:315 E DALE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1102
Practice Address - Country:US
Practice Address - Phone:719-291-5623
Practice Address - Fax:719-473-4066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5708101YA0400X
CO1385101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1952516338OtherKAISER PERMANENTE
CO1952516338OtherHUMANA
CO1952516338OtherAETNA
CO1952516338OtherTRICARE
CO1952516338OtherFORTIS
CO1952516338OtherCORPHEALTH
CO1952516338OtherINTEGRATED HEALTH PLAN
CO952516338OtherGREAT WEST HEALTHCARE
CO1952516338OtherMAGELLAN
CO1952516338OtherBCBS
CO1952516338OtherCIGNA
CO1952516338OtherMED ADVANTAGE
CO1952516338OtherCOVENTRY
1952516338OtherFIRST HEALTH NETWORK
CO1952516338OtherCOVENTRY HEALTH CARE NATIONAL NETWORK
CO1952516339OtherMHN
CO1952516338OtherVALUE OPTIONS
CO1952516338OtherUNICARE