Provider Demographics
NPI:1710467725
Name:FAUST, KEBRA (MS, NCC, BSL)
Entity Type:Individual
Prefix:
First Name:KEBRA
Middle Name:
Last Name:FAUST
Suffix:
Gender:F
Credentials:MS, NCC, BSL
Other - Prefix:
Other - First Name:KEBRA
Other - Middle Name:
Other - Last Name:SCHALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, NCC, BSL
Mailing Address - Street 1:151 E FELL ST
Mailing Address - Street 2:
Mailing Address - City:SUMMIT HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18250-1205
Mailing Address - Country:US
Mailing Address - Phone:570-449-1125
Mailing Address - Fax:
Practice Address - Street 1:4210 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:SCHNECKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18078-2580
Practice Address - Country:US
Practice Address - Phone:610-769-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-19
Last Update Date:2018-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor