Individual
THOMAS C FAIRBANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
2084 N 1700 W STE 6, LAYTON, UT 84041
(801) 773-7177
Mailing address
1767 N 2525 E, LAYTON, UT 84040
(801) 546-9515
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
109352-2501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
870465986000
—
UT
Enumeration date
12/05/2005
Last updated
10/18/2007
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