Theresa Fautz, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

KY1617 Issued in KY

Practice address

1448 Gardiner LN
Suite202-203
Louisville, KY 40213-1978

Phone

(502) 456-9998

Fax

(502) 456-9923

NPI assigned

Oct 3, 2006

Last updated

May 22, 2008By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bridgehaven, Inc.

  • Adult Mental Health Clinic/Center
  • Louisville, KY
  • NPI 1093823817
  NPD (past)
• Seven Counties Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Louisville, KY
  • NPI 1598793671
  NPD (past)
• US Psychiatry PLLC

  • Psychiatry Physician
  • Louisville, KY
  • NPI 1902255359
  NPD (past)
• Zafrin B Syed, M.D., PLLC

  • Psychiatry Physician
  • Louisville, KY
  • NPI 1790980464
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211414400000",
    "number": "1447345038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1448 GARDINER LANE",
            "address_2": "SUITE 202-203",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40213",
            "telephone_number": "502-456-9998",
            "fax_number": "502-456-9923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1448 GARDINER LN",
            "address_2": "SUITE202-203",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402131978",
            "telephone_number": "502-456-9998",
            "fax_number": "502-456-9923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAUTZ",
        "first_name": "THERESA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2008-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "KY",
            "license": "KY1617",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "82001066",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bryce Griffin Faulkner
• Jesse Faulkner
• Sarah Christine Faulkner, LPCC
• John O Faurest, M.D.
• Michael Andrew Fauser
• Adam Fauver
• Sharonda L Fawbush, OTR
• Stephanie Fawbush
• Rose Fawcett
• Marci Fawver, MS/CCC-SLP

• Mental Health Counselor in Louisville, KY
• Providers in Louisville, KY by specialty
• Mental Health Counselor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.