Provider Demographics
NPI:1396819488
Name:FAULKNER, PATRICIA L (LCPC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 438
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568
Mailing Address - Country:US
Mailing Address - Phone:217-824-4905
Mailing Address - Fax:217-824-3570
Practice Address - Street 1:730 NORTH PAWNEE
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568
Practice Address - Country:US
Practice Address - Phone:217-824-4905
Practice Address - Fax:217-824-3570
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001125526OtherBCBS