Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC.0016883 | CO |
N | 106S00000X | Behavior Technician |
NPI | 1003396516 |
---|---|
Provider Name | Kimberly Smith Faust |
First Address | Colorado Springs, CO 80916-2332 |
Second Address | Colorado Springs, CO 80910-3130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2018 |
Last Update Date | 11/10/2021 |