Healthcare Provider Details

I. General information

NPI: 1255051298
Provider Name (Legal Business Name): JANICE LYNN FAIRBANK LPC, LIAC, SAP, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8343 WILLOWPARK DR
GARDEN CITY ID
83714-1676
US

IV. Provider business mailing address

8343 WILLOWPARK DR
GARDEN CITY ID
83714-1676
US

V. Phone/Fax

Practice location:
  • Phone: 954-366-9978
  • Fax:
Mailing address:
  • Phone: 602-488-7417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2026-0500
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLIAC-15597
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC-8471063
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-LCPC-LIC-90419
License Number StateMT
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC.LH.70013113
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-23937
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: