Healthcare Provider Details

I. General information

NPI: 1083156954
Provider Name (Legal Business Name): TAYLOR FAUST M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 W ELM ST 104
MCHENRY IL
60050-4010
US

IV. Provider business mailing address

3430 HALE LN
ISLAND LAKE IL
60042-9639
US

V. Phone/Fax

Practice location:
  • Phone: 815-331-8768
  • Fax: 815-331-8760
Mailing address:
  • Phone: 847-977-7048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: