Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Indy Marie Fairbanks

Individual provider Addiction (Substance Use Disorder) Counselor · NPI 1013267756

Indy Marie Fairbanks is a Clinical Social Worker in Derby, Kansas. Qualified in 2006, 20 years ago. Practices with Tag Treatment Center LLC, an 8-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Kansas.

Years since qualifying
20
Licensed in
KS
In the registry since
2012
Specialties on file
2

Practice location Address checks out

402 N River St Ste 200
Derby, KS 67037-1539
Phone: (316) 409-0565
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 4661 (KS)
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X · Licence 647 (KS)

Record details

NPI number1013267756
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedSeptember 10, 2012
Last updated in NPPESDecember 16, 2025
Certification dateDecember 16, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2006 (20 years in practice)
Group practice Tag Treatment Center Llc — 8 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

Other providers in Derby