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General NPI Number Information
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NPI Number | 1912043860
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Entity Type | Individual
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Provider Name | FAUST BIANCO JR. PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 7146 S BRADEN AVE STE. 500
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City | TULSA
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State | OK
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Zip | 74136-6371
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Country | US
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Telephone | 918-488-6165
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Fax | 918-488-8021
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Provider Business Mailing Address
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Address Line | 1761 E 31ST ST
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City | TULSA
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State | OK
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Zip | 74105-2201
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Country | US
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Telephone | 918-746-0794
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Fax | 918-746-0717
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 754
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 579
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License Number State | HI
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 754
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 579
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License Number State | HI
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Taxonomy #5
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 754
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License Number State | OK
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Taxonomy #6
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 579
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License Number State | HI
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