Provider Demographics
NPI:1780738211
Name:FAUST, SHIRLEY C (PHD)
Entity type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:C
Last Name:FAUST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SHIRLEY
Other - Middle Name:FAUST
Other - Last Name:HELISTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:115 WALNUT
Mailing Address - Street 2:SUITE #2
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2086
Mailing Address - Country:US
Mailing Address - Phone:248-650-3200
Mailing Address - Fax:248-650-3225
Practice Address - Street 1:115 WALNUT
Practice Address - Street 2:SUITE #2
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-2086
Practice Address - Country:US
Practice Address - Phone:248-650-3200
Practice Address - Fax:248-650-3225
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003226103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OF330898681Medicare ID - Type Unspecified