Individual
INDY MARIE FAIRBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
402 N RIVER ST STE 200, DERBY, KS 67037-1539
(316) 409-0565
Mailing address
215 E 9TH AVE, BELLE PLAINE, KS 67013-8823
(316) 633-3262
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
647
KS
1041C0700X
Clinical Social Worker
Primary
4661
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200964810A
—
KS
Enumeration date
09/10/2012
Last updated
12/16/2025
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