Provider Demographics
NPI:1073264438
Name:FARLEY, REBECCA LEEANN (LMSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEEANN
Last Name:FARLEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 SE 35TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-7720
Mailing Address - Country:US
Mailing Address - Phone:405-412-8215
Mailing Address - Fax:
Practice Address - Street 1:808 SE 35TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-7720
Practice Address - Country:US
Practice Address - Phone:405-412-8215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7742101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health