Provider Demographics
NPI:1033709274
Name:FALTER, SHEENA NICOLE
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:NICOLE
Last Name:FALTER
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 1:1061 KY ROUTE 122
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:KY
Mailing Address - Zip Code:41649-9014
Mailing Address - Country:US
Mailing Address - Phone:606-910-4308
Mailing Address - Fax:606-439-2861
Practice Address - Street 1:1061 KY ROUTE 122
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:KY
Practice Address - Zip Code:41649-9014
Practice Address - Country:US
Practice Address - Phone:606-910-4308
Practice Address - Fax:606-439-2861
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY268140101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional