Individual
MARIA FAIRBOURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
7012 BEAMTREE DR, SHELBYVILLE, KY 40065-6328
(801) 367-3538
Mailing address
7012 BEAMTREE DR, SHELBYVILLE, KY 40065-6328
(801) 367-3538
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
252383
KY
Other
Enumeration date
05/10/2019
Last updated
05/10/2019
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