Individual
TIMOTHY FAIRBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISW
Contact information
Practice address
1290 JORDAN ST, NORTH LIBERTY, IA 52317-8020
(319) 249-0307
(319) 358-2367
Mailing address
1900 SILVER LAKE RD NW STE 110, NEW BRIGHTON, MN 55112-1789
(651) 628-9566
(651) 628-0411
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
081394
IA
1041C0700X
Clinical Social Worker
Primary
081394
IA
Other
Enumeration date
10/19/2022
Last updated
10/17/2024
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