Provider Demographics
NPI:1487842340
Name:FAUST PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:FAUST PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:FAUST
Authorized Official - Suffix:SR
Authorized Official - Credentials:PHD
Authorized Official - Phone:216-363-2363
Mailing Address - Street 1:1730 WEST 25TH ST.
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113
Mailing Address - Country:US
Mailing Address - Phone:216-363-2363
Mailing Address - Fax:216-696-7488
Practice Address - Street 1:1730 WEST 25TH ST.
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113
Practice Address - Country:US
Practice Address - Phone:216-363-2363
Practice Address - Fax:216-696-7488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4749103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0967584Medicaid
OH9311851Medicare UPIN
OHR98113Medicare UPIN
OH9311851Medicare PIN