Healthcare Provider Details

I. General information

NPI: 1891160024
Provider Name (Legal Business Name): CHRISTIAN FAUERSO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12335 W EMIG DR
LEAVENWORTH WA
98826-8750
US

IV. Provider business mailing address

12335 W EMIG DR
LEAVENWORTH WA
98826-8750
US

V. Phone/Fax

Practice location:
  • Phone: 509-219-3204
  • Fax: 509-219-3206
Mailing address:
  • Phone: 509-219-3204
  • Fax: 509-219-3206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC.LH.60909841
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC5079
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: