Healthcare Provider Details

I. General information

NPI: 1316741150
Provider Name (Legal Business Name): FAIR WINDS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7811 TOBIE LN
LINCOLN NE
68516-3857
US

IV. Provider business mailing address

PO BOX 6037
LINCOLN NE
68506-0037
US

V. Phone/Fax

Practice location:
  • Phone: 850-666-3732
  • Fax:
Mailing address:
  • Phone: 850-666-3732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ERIC SHAFFER
Title or Position: LICSW
Credential: LICSW
Phone: 850-666-3732