Pierre Henri Faillettaz, BA, MDIV, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

304389 Issued in MN

Practice address

3409 Portland Ave
Minneapolis, MN 55407-2023

Phone

(612) 999-8215

Fax

(651) 393-5161

NPI assigned

Jan 19, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

State licenses

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

{
    "created_epoch": "1547856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547856000000",
    "number": "1619441995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3409 PORTLAND AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554072023",
            "telephone_number": "612-999-8215",
            "fax_number": "651-393-5161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3409 PORTLAND AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554072023",
            "telephone_number": "612-999-8215",
            "fax_number": "651-393-5161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAILLETTAZ",
        "first_name": "PIERRE",
        "middle_name": "HENRI",
        "credential": "BA, MDIV, LADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-01-19",
        "last_updated": "2019-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "304389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsey Jeans Fahnhorst, RN
• Jeffrey Fahrenbruch, RPH
• Paul Fahrendorf, DPT
• Travis Donald Fahrenkamp, M.D.
• Steven Fahrner, RPT
• Scott J Fairbairn, M.D.
• Alyssa Fairbanks, RN, BSN
• Lea A Fairbanks, MD
• Katie J. Fairbourn
• Rey Fairburn

• Addiction (Substance Use Disorder) Counselor in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2019; 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.