Provider Demographics
NPI:1487849667
Name:FASULO-EMMOTT, BARBARA SHARON (LPC, CCS-M)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:SHARON
Last Name:FASULO-EMMOTT
Suffix:
Gender:F
Credentials:LPC, CCS-M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2677 CHAPERON DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49696-8565
Mailing Address - Country:US
Mailing Address - Phone:231-929-1968
Mailing Address - Fax:
Practice Address - Street 1:1105 SIXTH STREET
Practice Address - Street 2:MUNSON BEHAVIORAL HEALTH SERVICES
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-935-6390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401001913101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional