Individual
ROBERT DANIEL FAIRBANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
200 N ANDERSON LN, LINDON, UT 84042-1110
(801) 785-1761
Mailing address
200 N ANDERSON LN, LINDON, UT 84042-1110
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
56012843502
UT
1041C0700X
Clinical Social Worker
Primary
5601284-3501
UT
Other
Enumeration date
08/18/2011
Last updated
06/17/2015
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