Individual
PAUL DOUGLAS FAIRBANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC / LPC
Contact information
Practice address
1175 OLD HIGHWAY 66, ROGERSVILLE, TN 37857-5175
(815) 566-0466
Mailing address
1175 OLD HIGHWAY 66, ROGERSVILLE, TN 37857-5175
(815) 566-0466
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-23438
AZ
101YP2500X
Professional Counselor
180011693
IL
Other
Enumeration date
12/03/2014
Last updated
01/30/2026
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