Provider Demographics
NPI:1912043860
Name:BIANCO, FAUST JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:FAUST
Middle Name:
Last Name:BIANCO
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-2201
Mailing Address - Country:US
Mailing Address - Phone:918-746-0794
Mailing Address - Fax:918-746-0717
Practice Address - Street 1:7146 S BRADEN AVE
Practice Address - Street 2:STE. 500
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6371
Practice Address - Country:US
Practice Address - Phone:918-488-6165
Practice Address - Fax:918-488-8021
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK754103G00000X, 103TC0700X, 103TH0100X
HI579103G00000X, 103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical