Healthcare Provider Details

I. General information

NPI: 1659671352
Provider Name (Legal Business Name): JOHN FAUST LMHC CDC-1
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2010
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3245 HOSPITAL DR
JUNEAU AK
99801-7809
US

IV. Provider business mailing address

PO BOX 464
KLAWOCK AK
99925-0464
US

V. Phone/Fax

Practice location:
  • Phone: 206-696-0717
  • Fax:
Mailing address:
  • Phone: 206-478-0315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3016
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: