Individual
LAURA FAUST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 RANCH HOUSE RD, CIBOLO, TX 78108-4346
(877) 712-2735
Mailing address
4225 WEDDINGTON MATTHEWS RD, WEDDINGTON, NC 28104-9403
(877) 712-2735
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-17-25827
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-17-25827
HMO BLUE TEXAS, BLUE CHOICE PPO, BLUE ADVANTAGE PREMIER, AND BLUE PREMIER
—
Enumeration date
03/30/2017
Last updated
03/30/2017
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