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COYOTE FAIRBANK LCSW
NPI 1447783170
Social Worker - Clinical in Polson, MT

Active since April 10, 2017Opted out of Medicare · through Jul 1, 2028

NPPES record last updated: November 27, 2023. Verified against the NPPES registry weekly; last sync: September 20, 2026.

Record update history: Oct 14, 2020, Jun 29, 2020, Dec 18, 2019 and 1 more (4 updates tracked since 2017).

About Coyote Fairbank Lcsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COYOTE FAIRBANK LCSW (NPI 1447783170) is an individual clinical provider in Polson, Montana, licensed in Montana (BBH-LCSW-LIC-23635) and active in the NPI registry since April 2017. He has opted out of Medicare through July 1, 2028 and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1447783170
Entity TypeIndividualMale
Primary Taxonomy1041C0700X
Provider Legal NameCOYOTE FAIRBANKCredential: LCSW
Location Address2 6TH AVE EPolson, MT 59860-2726
Mailing AddressPo Box 181Polson, MT 59860-0181 · (406) 214-3137
Phone(406) 214-3137
Sole ProprietorYes
Enumeration DateApril 10, 2017
Last NPPES UpdateNovember 27, 20234 updates tracked since enumeration
NPPES CertifiedOctober 14, 2020
✔ NPI 1447783170 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in MT · BBH-LCSW-LIC-23635
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
2 6TH AVE E, Polson, MT 59860
Open in Google Maps ↗

Secondary Practice Locations 2

Location 17935 Mt Highway 35 Ste 202Bigfork, MT 59911-5711 · Phone (406) 214-3137
Location 21602 2nd St WPolson, MT 59860-4005 · Phone (406) 214-3137

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Montana, PacificSource Health Plans.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Coyote Fairbank Lcsw has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from July 1, 2024 through July 1, 2028.

Opt-Out Effective DateJuly 1, 2024
Opt-Out In Effect ThroughJuly 1, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANNE D LOWE LCSW
Social Worker (Clinical)
2 6TH AVE E
POLSON, MT 59860
Lake County (360) 672-1548
SHAINA LYNN FAIRBANK LCSW
Social Worker (Clinical)
2 6TH AVE E
POLSON, MT 59860
Lake County (406) 303-3564
SAMUEL HEPBURN ORE LCSW
Social Worker (Clinical)
2 6TH AVE E
POLSON, MT 59860
Lake County (406) 241-1693
CRAIG LYLE STEVENSON LCSW
Social Worker (Clinical)
2 6TH AVE E
POLSON, MT 59860
Lake County (406) 439-7401
FAIRBANK COUNSELING, PLLC
Social Worker (Clinical)
2 6TH AVE E
POLSON, MT 59860
Lake County (406) 214-3137
MS. REBECCA LEIGH ALLEN LCSW
Social Worker (Clinical)
2 6TH AVE E
POLSON, MT 59860
Lake County (406) 885-2693
WAXWING PSYCHOTHERAPY LIMITED LIABILITY PARTNERSHIP
Social Worker (Clinical)
2 6TH AVE E
POLSON, MT 59860
Lake County (406) 241-1693
MIND FLOW THERAPEUTICS LLC
Social Worker (Clinical)
2 6TH AVE E
POLSON, MT 59860
Lake County (406) 439-7401

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Coyote Fairbank's NPI number?

The NPI number for Coyote Fairbank is 1447783170. It was assigned to this individual provider in the NPPES registry on April 10, 2017.

Where is Coyote Fairbank located?

Coyote Fairbank practices at 2 6th Ave E, Polson, MT 59860. The listed phone number is (406) 214-3137.

What is Coyote Fairbank's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Coyote Fairbank enrolled in Medicare?

No. Coyote Fairbank has opted out of Medicare through July 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

What insurance does Coyote Fairbank accept?

Health plans from Blue Cross and Blue Shield of Montana and PacificSource Health Plans list Coyote Fairbank as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Coyote Fairbank was last updated on November 27, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.