Provider Demographics
NPI:1326664459
Name:FAULKNER, ADAM T (MS, LPC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:T
Last Name:FAULKNER
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N 5TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-1808
Mailing Address - Country:US
Mailing Address - Phone:636-238-2615
Mailing Address - Fax:636-201-3379
Practice Address - Street 1:400 N 5TH ST STE 201
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-1808
Practice Address - Country:US
Practice Address - Phone:636-238-2615
Practice Address - Fax:636-201-3379
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020029483101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional