Individual
ANTHONY JAMES FAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA QMHP
Contact information
Practice address
104 NORTHTOWN DR, SPARTA, IL 62286-1081
(618) 282-6233
Mailing address
10257 STATE ROUTE 3, RED BUD, IL 62278-4418
(217) 520-5315
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
101YS0200X
School Counselor
2437595
IL
Other
Enumeration date
10/10/2023
Last updated
05/22/2024
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