MEDICARE: BRUCE L. FAIRMAN M.S. L.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	CO #333	OR

General Provider Information

NPI Number	:	1649367400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE L. FAIRMAN M.S. L.P.C.

Provider Business Mailing Address
First Line	:	PO BOX 1206
Second Line	:
City	:	NEWPORT
State	:	OR
Zip	:	97365
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1686 N COAST HWY
Second Line	:
City	:	NEWPORT
State	:	OR
Zip	:	97365-2357
Country	:	US
Telephone Number	:	541-265-6148
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	04/09/2015

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Directions to “ BRUCE L. FAIRMAN M.S. L.P.C.” Practice Location

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