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NPI Code Detail

MEDICARE: DR. ALISA JILL FAUST-HALLE PSY.D.

MEDICARE: DR. ALISA JILL FAUST-HALLE PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist20041879AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851499081
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALISA JILL FAUST-HALLE PSY.D.
Provider Business Mailing Address
First Line : 6060 N COLLEGE AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46220-1907
Country : US
Telephone Number : 317-254-3317
Fax Number : 317-726-0257
Provider Business Practice Location Address
First Line : 6060 N COLLEGE AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46220-1907
Country : US
Telephone Number : 317-254-3317
Fax Number : 317-726-0257
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 02/26/2013

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