Provider Demographics
NPI:1609852417
Name:FAULKNER, SHIRLEY ANN (LCMFT, LCAC)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ANN
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:LCMFT, LCAC
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:
Other - Last Name:COLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2700 E 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502
Mailing Address - Country:US
Mailing Address - Phone:620-663-8484
Mailing Address - Fax:620-662-4757
Practice Address - Street 1:2700 E 30TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502
Practice Address - Country:US
Practice Address - Phone:620-663-8484
Practice Address - Fax:620-662-4757
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS081106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS081OtherLCMFT
11552OtherNAADAC