Healthcare Provider Details

I. General information

NPI: 1306783097
Provider Name (Legal Business Name): COLBY FAIRLESS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 LINCOLN WAY
AUBURN CA
95603-4380
US

IV. Provider business mailing address

318 LINCOLN WAY
AUBURN CA
95603-4380
US

V. Phone/Fax

Practice location:
  • Phone: 916-201-2621
  • Fax:
Mailing address:
  • Phone: 530-745-4061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1431570226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: