MEDICARE: XANDER FAISON CMII,LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LC6684	MD
2	171M00000X	Case Manager/Care Coordinator
3	103TC2200X	Clinical Child & Adolescent Psychologist

General Provider Information

NPI Number	:	1255959508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XANDER FAISON CMII,LPC

Provider Business Mailing Address
First Line	:	4512 SUNNYVIEW DR APT 178
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-3163
Country	:	US
Telephone Number	:	443-991-1582
Fax Number	:

Provider Business Practice Location Address
First Line	:	7917 N MAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-4540
Country	:	US
Telephone Number	:	405-938-1194
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	12/31/2024

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