Provider Demographics
NPI:1881960854
Name:LISA FAULKNER
Entity type:Organization
Organization Name:LISA FAULKNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DAILY LIVING ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-789-7915
Mailing Address - Street 1:350 CITY VIEW DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-5327
Mailing Address - Country:US
Mailing Address - Phone:307-789-7915
Mailing Address - Fax:
Practice Address - Street 1:350 CITY VIEW DR
Practice Address - Street 2:SUITE 302
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-5327
Practice Address - Country:US
Practice Address - Phone:307-789-7915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIONEER COUNSELING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-23
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty