MEDICARE: DUSTIN MARK FAULKNER PC

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	101Y00000X	Counselor		OH
2	101YP2500X	Professional Counselor	C.0500461-CR	OH

General Provider Information

NPI Number	:	1316901812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTIN MARK FAULKNER PC

Provider Business Mailing Address
First Line	:	1251 NILLES RD STE 5
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-7205
Country	:	US
Telephone Number	:	513-939-0300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1251 NILLES RD STE 5
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-7205
Country	:	US
Telephone Number	:	513-939-0300
Fax Number	:

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	05/08/2008

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Directions to “ DUSTIN MARK FAULKNER PC” Practice Location

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