Individual
TARA KIM FAIRBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CAP - 207
Contact information
Practice address
1430 WILKINS CIR, CASPER, WY 82601-1336
(307) 237-9588
Mailing address
2424 E 9TH ST, CASPER, WY 82609-2838
(307) 267-7253
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
207
WY
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
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Other
Enumeration date
10/03/2024
Last updated
10/17/2024
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