Provider Demographics
NPI:1851499081
Name:FAUST-HALLE, ALISA JILL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:JILL
Last Name:FAUST-HALLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6060 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1907
Mailing Address - Country:US
Mailing Address - Phone:317-254-3317
Mailing Address - Fax:317-726-0257
Practice Address - Street 1:6060 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1907
Practice Address - Country:US
Practice Address - Phone:317-254-3317
Practice Address - Fax:317-726-0257
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041879A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200460920Medicaid
IN200460920Medicaid