Provider Demographics
NPI:1770996985
Name:FAUGHT, RAELENE (MA)
Entity type:Individual
Prefix:
First Name:RAELENE
Middle Name:
Last Name:FAUGHT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:RAELENE
Other - Middle Name:
Other - Last Name:REYNODS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8052 MATTERHORN LN APT D113
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-1154
Mailing Address - Country:US
Mailing Address - Phone:219-775-2441
Mailing Address - Fax:
Practice Address - Street 1:8052 MATTERHORN LN APT D113
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-1154
Practice Address - Country:US
Practice Address - Phone:219-775-2441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012010101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional