Provider Demographics
NPI:1891227724
Name:FAUST, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:FAUST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 WEDDINGTON MATTHEWS RD
Mailing Address - Street 2:
Mailing Address - City:WEDDINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28104-9403
Mailing Address - Country:US
Mailing Address - Phone:877-712-2735
Mailing Address - Fax:
Practice Address - Street 1:100 RANCH HOUSE RD
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-4346
Practice Address - Country:US
Practice Address - Phone:877-712-2735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-17-25827103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-17-25827OtherHMO BLUE TEXAS, BLUE CHOICE PPO, BLUE ADVANTAGE PREMIER, AND BLUE PREMIER