Fairbank, Thomas C

Fairbank, Thomas C is an individual health care provider with primary practice located at 2084 N 1700 W Ste 6 , Layton UT 84041. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Fairbank, Thomas C can be contacted via phone (801) 773-7177.

Contact Information

Primary practice address
2084 N 1700 W Ste 6 Layton UT 84041
Phone: (801) 773-7177
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 109352-2501 Utah

Profile Details

NPI number 1194709980
LBN Legal business name Fairbank, Thomas C
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 5th, 2005
Last updated Oct 18th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1194709980 NPPES
Utah MEDICAID 870465986000

Popular Providers