Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | PHD-419 | WY |
N | 101YM0800X | Mental Health Counselor | PHD-419 | WY |
Y | 102L00000X | Psychologist | PHD-419 | WY |
Y | 103T00000X | Psychologist | PHD-419 | WY |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PHD-419 | WY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PHD-419 | WY |
NPI | 1578784377 |
---|---|
Provider Name | Earl H Faulkner |
First Address | Fe Warren Afb, WY 82005-3906 |
Second Address | Fe Warren Afb, WY 82005-3906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
122963000 | (05) | WY |