Fairbanks, William D

Fairbanks, William D is an individual health care provider with primary practice located at 2526 Seymour Ave , Cheyenne WY 82001-3159. He recently has only one registered license in Behavioral Health & Social Service Providers / Counselor, which is considered as his primary health care specialty. Fairbanks, William D can be contacted via phone (307) 634-9653.

Contact Information

Primary practice address
2526 Seymour Ave Cheyenne WY 82001-3159
Phone: (307) 634-9653
Fax: (307) 638-8256
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X 261 Wyoming

Profile Details

NPI number 1114901964
LBN Legal business name Fairbanks, William D
Credentials PH.D., LPC
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 5th, 2005
Last updated Mar 15th, 2011 - about 13 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114901964 NPPES
Wyoming Other 311734 BS OF WY
Wyoming Other MH60 BS OF WY

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