Provider Demographics
NPI:1316545452
Name:FAUSTI, KAYLA JOANNE (LPC, SAC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:JOANNE
Last Name:FAUSTI
Suffix:
Gender:F
Credentials:LPC, SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 ENGEL DR APT 102
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-3756
Mailing Address - Country:US
Mailing Address - Phone:715-701-3552
Mailing Address - Fax:
Practice Address - Street 1:1671 HOFFMAN RD STE 170
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6232
Practice Address - Country:US
Practice Address - Phone:920-288-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10993-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1003150004Medicaid
WI10993OtherWISCONSIN LICENSED PROFESSIONAL COUNSELOR