| Life Anchor Counseling Llc | |
|
1221 N Rock Rd Ste 100 Derby KS 67037-3675 | |
| (316) 633-3262 | |
| Not Available |
| Full Name | Life Anchor Counseling Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1221 N Rock Rd Ste 100, Derby, Kansas |
| Authorized Official Name and Position | Indy Fairbanks (OWNER) |
| Authorized Official Contact | 3166333262 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Anchor Counseling Llc 215 E 9th Ave Belle Plaine KS 67013-8823 Ph: (316) 633-3262 | Life Anchor Counseling Llc 1221 N Rock Rd Ste 100 Derby KS 67037-3675 Ph: (316) 633-3262 |
| NPI Number | 1013604891 |
|---|---|
| Provider Enumeration Date | 04/20/2023 |
| Last Update Date | 04/20/2023 |
| Certification Date | 04/20/2023 |
| Medicare PECOS PAC ID | 9032574520 |
|---|---|
| Medicare Enrollment ID | O20230505002243 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013604891 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Indy M Fairbanks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013267756 PECOS PAC ID: 8729355573 Enrollment ID: I20170525002063 |
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