Provider Demographics
NPI:1326006230
Name:FAUST, TRACY JENIFER (MA, LPC, SAC, NCC)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:JENIFER
Last Name:FAUST
Suffix:
Gender:F
Credentials:MA, LPC, SAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3292 DAVIES AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-7200
Mailing Address - Country:US
Mailing Address - Phone:414-540-2170
Mailing Address - Fax:414-540-2171
Practice Address - Street 1:3900 W BROWN DEER RD STE 200
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53209-1220
Practice Address - Country:US
Practice Address - Phone:414-540-2170
Practice Address - Fax:414-540-2171
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13199101YA0400X
WI3237-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)