Provider Demographics
NPI:1114947330
Name:FAULKNER, BRENDA SUE (LPC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:SUE
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 COUNTY ROAD 284
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:TX
Mailing Address - Zip Code:76446-7001
Mailing Address - Country:US
Mailing Address - Phone:254-445-4503
Mailing Address - Fax:254-445-4742
Practice Address - Street 1:14767 S US HIGHWAY 377
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:TX
Practice Address - Zip Code:76446-4371
Practice Address - Country:US
Practice Address - Phone:254-485-0444
Practice Address - Fax:254-445-4742
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16697101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional