Provider Demographics
NPI:1013362235
Name:FAUSSET, ERIN
Entity Type:Individual
Prefix:MISS
First Name:ERIN
Middle Name:
Last Name:FAUSSET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-1739
Mailing Address - Country:US
Mailing Address - Phone:307-778-8686
Mailing Address - Fax:
Practice Address - Street 1:3701 RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-1739
Practice Address - Country:US
Practice Address - Phone:307-778-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health