Provider Demographics
NPI:1083156954
Name:FAUST, TAYLOR (MA)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:FAUST
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 HALE LN
Mailing Address - Street 2:
Mailing Address - City:ISLAND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60042-9639
Mailing Address - Country:US
Mailing Address - Phone:847-977-7048
Mailing Address - Fax:
Practice Address - Street 1:5400 W ELM ST
Practice Address - Street 2:104
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4010
Practice Address - Country:US
Practice Address - Phone:815-331-8768
Practice Address - Fax:815-331-8760
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health