Individual
MS. JANICE LYNN FAIRBANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, LIAC, SAP
Contact information
Practice address
951 E PLAZA DR, EAGLE, ID 83616-6566
(208) 938-2836
Mailing address
6317 WEST AVILLA STREET , MERIDIAN, ID, MERIDIAN, ID 83646
(602) 488-7417
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LIAC-15597
AZ
101YM0800X
Mental Health Counselor
Primary
LCPC-8471063
ID
101YP2500X
Professional Counselor
LPC-23937
AZ
Other
Enumeration date
08/30/2022
Last updated
03/25/2026
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