Healthcare Provider Details

I. General information

NPI: 1326006230
Provider Name (Legal Business Name): TRACY JENIFER FAUST M.A., LPC, SAC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5406 HE TOWNLINE RD
GREEN BAY WI
54311-9573
US

IV. Provider business mailing address

5406 HE TOWNLINE RD
GREEN BAY WI
54311-9573
US

V. Phone/Fax

Practice location:
  • Phone: 920-468-8646
  • Fax: 920-468-8646
Mailing address:
  • Phone: 920-468-8646
  • Fax: 920-468-8646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13199
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5501
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3237-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: