Doctor Name: | MS. KRISTIN J FAIREY |
NPI Number: | 1497997860 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA LMHC |
License Number: | 0113581 |
Business Practice Address: | 99 D Avenue Zuni, NM - 87327 |
Business Phone Number: | 5057824710 |
Business Fax Number: | 5057825880 |
Mailing Address: | Po Box 339, ZUNI |
State: | NM |
Postal Code: | 873270339 |
Phone Number: | 5057824710 |
Fax Number: | 5057825880 |
NPI Enumeration Date: | 04/01/2009 |
NPI Last Update Date: | 07/08/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 0113581 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |