Provider Demographics
NPI:1215524368
Name:FAIRFIELD BAPTIST
Entity type:Organization
Organization Name:FAIRFIELD BAPTIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, RPT
Authorized Official - Phone:409-292-9172
Mailing Address - Street 1:27240 HIGHWAY 290
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-4907
Mailing Address - Country:US
Mailing Address - Phone:409-292-9170
Mailing Address - Fax:
Practice Address - Street 1:27240 HIGHWAY 290
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-4907
Practice Address - Country:US
Practice Address - Phone:409-292-9170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN BAPTISTS OF TEXAS CONVENTION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty