Provider Demographics
NPI:1902132343
Name:FAIRCHILD, JANEL MARIE (MC)
Entity Type:Individual
Prefix:
First Name:JANEL
Middle Name:MARIE
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42104 VENTURE DR
Mailing Address - Street 2:BUILDING D, UNIT 3
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086
Mailing Address - Country:US
Mailing Address - Phone:480-250-4245
Mailing Address - Fax:
Practice Address - Street 1:42104 N VENTURE DR
Practice Address - Street 2:BUILDING D, UNIT 3
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3823
Practice Address - Country:US
Practice Address - Phone:480-250-4245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 13320101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional