Healthcare Provider Details

I. General information

NPI: 1114947330
Provider Name (Legal Business Name): BRENDA SUE FAULKNER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14767 S US HIGHWAY 377
DUBLIN TX
76446-4371
US

IV. Provider business mailing address

2016 COUNTY ROAD 284
DUBLIN TX
76446-7001
US

V. Phone/Fax

Practice location:
  • Phone: 254-485-0444
  • Fax: 254-445-4742
Mailing address:
  • Phone: 254-445-4503
  • Fax: 254-445-4742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16697
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: