Provider Demographics
NPI:1366944019
Name:FALENCIK, AUDREY MARIE (MS MFT COUNSELING)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:MARIE
Last Name:FALENCIK
Suffix:
Gender:F
Credentials:MS MFT COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6394
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-6394
Mailing Address - Country:US
Mailing Address - Phone:951-963-5825
Mailing Address - Fax:
Practice Address - Street 1:252 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4012
Practice Address - Country:US
Practice Address - Phone:951-318-1351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty