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General NPI Number Information
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NPI Number | 1255051298
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Entity Type | Individual
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Provider Name | JANICE LYNN FAIRBANK LPC, LIAC, SAP
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Gender | Female
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Dates
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Enumeration Date | 08/30/2022
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 7373 N SCOTTSDALE RD STE 185
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City | SCOTTSDALE
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State | AZ
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Zip | 85253-3559
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Country | US
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Telephone | 480-764-3242
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Fax |
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Provider Business Mailing Address
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Address Line | 5250 N 20TH ST APT 117
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City | PHOENIX
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State | AZ
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Zip | 85016-3346
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Country | US
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Telephone | 602-488-7417
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LIAC-15597
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-23937
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License Number State | AZ
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