Provider Demographics
NPI:1891160024
Name:FAUERSO, CHRISTIAN
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:FAUERSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12335 W EMIG DR
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:WA
Mailing Address - Zip Code:98826-8750
Mailing Address - Country:US
Mailing Address - Phone:509-219-3204
Mailing Address - Fax:509-219-3206
Practice Address - Street 1:12335 W EMIG DR
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:WA
Practice Address - Zip Code:98826-8750
Practice Address - Country:US
Practice Address - Phone:509-219-3204
Practice Address - Fax:509-219-3206
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor