Provider Demographics
NPI:1134218803
Name:FALTISCO, MICHAEL A (LMHC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:FALTISCO
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21618 84TH PL W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7824
Mailing Address - Country:US
Mailing Address - Phone:425-771-4825
Mailing Address - Fax:
Practice Address - Street 1:21618 84TH PL W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7824
Practice Address - Country:US
Practice Address - Phone:425-771-4825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006264101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health