Provider Demographics
NPI:1285339978
Name:FAIR, MANDY M (LMFT)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:M
Last Name:FAIR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:M
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:8207 HUDSON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2805
Mailing Address - Country:US
Mailing Address - Phone:806-392-7374
Mailing Address - Fax:
Practice Address - Street 1:3601 4TH ST STOP 8119
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-0002
Practice Address - Country:US
Practice Address - Phone:806-743-3998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202839106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist