Kenneth William Fausett Sr., LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

LMFT-15484 Issued in AZ

Practice address

276 Lake Havasu Ave S Apt C32
Lake Havasu City, AZ 86403-6521

Phone

(928) 813-8977

NPI assigned

Jun 19, 2020

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

State licenses

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

{
    "created_epoch": "1592524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600300800000",
    "number": "1851917413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "276 LAKE HAVASU AVE S APT C32",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036521",
            "telephone_number": "928-813-8977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "276 LAKE HAVASU AVE S APT C32",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036521",
            "telephone_number": "928-813-8977"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "151 Riviera Dr Ste B",
            "address_purpose": "LOCATION",
            "city": "Lake Havasu City",
            "state": "AZ",
            "postal_code": "864035740",
            "country_code": "US",
            "telephone_number": "417-569-3008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAUSETT",
        "first_name": "KENNETH",
        "middle_name": "WILLIAM",
        "name_suffix": "Sr.",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-06-19",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "AZ",
            "license": "LMFT-15484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Marriage & Family Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; 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.