Individual
COYOTE FAIRBANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2 6TH AVE E, POLSON, MT 59860-2726
(406) 214-3137
Mailing address
PO BOX 181, POLSON, MT 59860-0181
(406) 214-3137
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
BBH-LCSW-LIC-23635
MT
Other
Enumeration date
04/10/2017
Last updated
11/27/2023
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