Provider Demographics
NPI:1922341353
Name:FAULKNER, JOHNNY (PHD, LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:FAULKNER
Suffix:
Gender:M
Credentials:PHD, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-5133
Mailing Address - Country:US
Mailing Address - Phone:479-858-8899
Mailing Address - Fax:
Practice Address - Street 1:211 E 4TH ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-5133
Practice Address - Country:US
Practice Address - Phone:479-858-8899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARM2308005101Y00000X
ARP2308023101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor