Provider Demographics
NPI:1265151906
Name:FAITH FACTORY LLC
Entity type:Organization
Organization Name:FAITH FACTORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:262-706-5868
Mailing Address - Street 1:790 N MILWAUKEE ST STE 312
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3724
Mailing Address - Country:US
Mailing Address - Phone:262-706-5868
Mailing Address - Fax:
Practice Address - Street 1:790 N MILWAUKEE ST STE 312
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3724
Practice Address - Country:US
Practice Address - Phone:262-706-5868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty